A simple plethysmographic method for differentiating primary from secondary varicose veins

Characteristics of venous flow were studied in 81 normal legs and in 98 legs with varicose vein disorders. The change in the volume in the calf after calf muscle contractions was studied using the strain gauge technique with the patients in the erect position. During contractions of the calf muscle, the volume in the calf decreases, chiefly because of reduction of blood volume in the veins. After cessation of the contractions, there is a gradual return of volume to precontraction values. This was measured in seconds and called venous return time and in milliliters times 100 milliliters of tissue-1 times minutes-1 and called venous reflux flow. In normal persons, the venous return time was 21.9+/-6.7 (S.D.) seconds, and in patients with venous disorders, the corresponding time was 6.9+/-2.9 (S.D.) seconds. Venous reflux flow which was inversely correlated with the venous return time was 11.4+/-4.9 and 22.3+/-7.3 (S.D.), respectively. A good correlation was found between venous return time and venous pressure measurements. No age or sex differences were seen. In patients with superficial venous insufficiency, the venous return time and venous reflux time became normal when the diseased portion of the vein was compressed. In patients with insufficient perforating veins or damaged deep vein valves, external compression did not change venous flow characteristics. This indicates that the method can be used preoperatively to differentiate between primary and secondary varicose veins and, thus, influence the type of operation to be performed. The method can easily be applied for clinical purposes.     

Hand-held Doppler as a screening test in primary varicose veins

BACKGROUND: Hand-held Doppler is in common use for evaluating varicose veins, but its accuracy in identifying the exact sites of venous reflux is inferior to that of duplex scanning. It has been suggested that duplex should be used to investigate all varicose veins, but this is currently impractical, and should be unnecessary if hand-held Doppler examination were shown to be an adequate screening test. METHODS: Eighty-five patients (122 legs) with primary varicose veins were evaluated using a hand-held Doppler in the outpatient clinic, according to a protocol. Patients then had venous duplex imaging. RESULTS: Different methods of assessing the long saphenous vein (LSV) (tourniquet and tapping tests, and examination at and below the groin) had similar sensitivities for detecting reflux (75-86 per cent), and together detected 91 per cent of cases. Six of the nine missed had a competent saphenofemoral junction, and five had low-velocity reflux. Hand-held Doppler assessment missed 11 cases of popliteal fossa reflux; only four involved the short saphenous vein (SSV), and most had low-velocity popliteal vein reflux. CONCLUSION: Hand-held Doppler examination missed LSV or SSV incompetence in 11 per cent of legs, but these included cases with short-duration and low-velocity reflux of dubious clinical importance.     

Preoperative duplex imaging is required before all operations for primary varicose veins

BACKGROUND: Physical examination is unreliable in the detection of sources of reflux in varicose veins. Hand-held Doppler (HHD) ultrasonography has been recommended as an accurate adjunct to physical examination. The aim of this study was to evaluate the accuracy of HHD imaging in comparison with duplex ultrasonography. METHODS: Eighty-nine legs in 61 patients with primary varicose veins were examined with an HHD probe to detect reflux at the saphenofemoral junction (SFJ), the saphenopopliteal junction (SPJ) and in thigh perforators (TPs). Patients then underwent duplex imaging and the results of the tests were compared. RESULTS: The sensitivity of the HHD technique was 73 per cent at the SFJ, 77 per cent at the SPJ and 51 per cent for TPs. In primary varicose veins the surgery planned using HHD imaging alone would have left residual sites of reflux in 24 per cent. CONCLUSION: Examination with HHD ultrasonography is not sufficiently accurate to plan varicose vein surgery. Duplex imaging is recommended before all operations for primary varicose veins.     

The psychosomatic aspects of complaints of varicose veins during pregnancy. A psychosometric investigation in 345 antenatal patients (author's transl)

A discrepancy between complaints of varicose veins of the legs such as stabbing in the legs, pain in the legs, tiredness of the legs, heaviness of the legs, feeling of swelling in the legs and nocturnal cramps in the calves, and anatomical signs of varicose veins in the legs was observed. Therefore these complaints were analyzed in 345 antenatal patients regarding their psychological aspects. No complaints of venous insufficiency were found in 47% of the pregnant women. Of the 53% antenatal patients with complaints, 24% had mild, 18% had moderate and 11% had severe complaints. Antenatal patients with well noticable neurotic personality traits in the MPI had complaints twice as often as women without neurotic traits (p smaller than 0.05). Introverted antenatal patients (according to the MPI) had more venous leg complaints than expected (p smaller than 0.05). Pregnant women with frequent psychosomatic complaints and altered general well being had the highest incidence of varicose veins complaints (p smaller than 0.001) or p smaller than 0.05). In addition to these psychometric data, there was also a correlation of the gynaecological history with complaints of venous insufficiency in the legs during pregnancy. Pregnant women with a very painful menarche had more varicose vein complaints than expected (p smaller than 0.05). The incidence was also higher with a history of abortion (p smaller than 0.05), marked dysmenorrhea (p smaller than 0.01) and side effects from oral contraception (p smaller than 0.01) and in primigravida (p smaller than 0.05). Age was only correlated to the symptom of stabbing pain in the legs in a statistically significant correlation (p smaller than 0.05). The results were tested statistically for significance with the X2-method.     

Recurrent varices of the lower extremities and their causes

Surgery of both primary and secondary varicose veins represents a serious medical and social problem. Middle-age patients are primarily affected. Hence, a great attention to this problem is appropriate and the surgery should be performed with great responsibility. On principle, we are opposed to sclerotization of veins as a primary medical treatment. During the surgery of varicose veins, a great attention should be paid to perfect crossectomy with ligation of all branches and leaving a short stump of vein saphena magna. The most important phase of the surgery, however, is the finding incompetent perforating veins (IP) and their correct treatment, since these are, as follows from our work, the most frequent cause of relapses. Incorrectly treated or left-out IP veins play a key role in the ethology of relapses. These IP veins are very often much broader then the original surface varicose veins. Pre-treatment examination is extremely important. It is necessary to know the condition of deep vein system and to find or identify IP veins. In no circumstances should the relapse veins (RV) surgery be limited to the deletion of varicose veins only. Reexamination of groin should be a rule. The rule of treating the cause and not the consequence should be valid in the case of RV surgery more then anywhere else.     

Color duplex ultrasound in the assessment of primary venous leg ulceration

METHODS: To determine the extent and severelity of venous reflux, color duplex ultrasound was used in 370 limbs of 303 patients with primary varicose veins. The clinical findings were classified according to the CEAP (clinical, etiologic, anatomic, pathophysiologic) clinical classification. RESULTS: Of 370 limbs, 32 showed previously healed ulcer (Class 5) and active ulcer (Class 6). Overall reflux in the superficial venous system was seen in 28 limbs (87.5%), and solitary superficial vein incompetence was detected in 13 (40.6%). Reflux was detected throughout the length of the superficial vein system, and the retrograde peak velocity was greater than 30 cm/second in these limbs. Reflux in the perforating veins was detected in 14 limbs (43.8%), but isolated perforating vein incompetence was seen in only one limb (3.1%). Deep vein incompetence was detected in 12 limbs (37.5%). Concomitant superficial and perforating vein reflux was evident in 4 limbs (12.5%) and 2 limbs (6.3%), respectively, but isolated deep vein incompetence was detected in only one limb (3.1%). The operations indicated were selective stripping of the long saphenous vein in the thigh, high ligation of the short saphenous vein, subfascial ligation of perforating veins, and compression sclerotherapy for varicose tributary veins. Healing of the ulcers was achieved within 1 month after surgery, and the postoperative color duplex scanning revealed correction of deep vein incompetence. CONCLUSIONS: These data suggest that ablation of the superficial vein system and the perforating veins is an appropriate method for the management of patients with primary venous leg ulceration.     

辊形配置对辊间接触压力与板形调控影响分析

为系统分析不同辊形配置下辊间接触压力分布形式与板形调控特性,以某1 800 mm热轧生产线使用的2种典型辊形配置为研究对象,建立对应的辊系有限元模型,计算不同带钢规格与调控手段下辊间接触压力分布形式,分析得出常规凸度支撑辊对应的辊间接触压力分布形式与CVC工作辊辊形呈现出明显的对应性,且压力分布形式受轧制规格与调控手段的影响明显小于CVC支撑辊。利用接触压力峰值和不均匀度表述辊间接触压力分布特征,将不同规格与调控手段对辊间接触压力分布特征的影响进行量化处理,得到更为具体的不同参量在整个变化范围内对分布特征的整体影响趋势。同时还对2种辊形配置下不同辊间接触压力对轧机板形调控特性影响进行分析,得出CVC支撑辊对应辊形配置的弯辊力与窜辊位置在板形调控能力上均强于常规凸度支撑辊辊形配置,而不同辊形配置对辊缝形状的影响表现出较为明显的差异,引入辊间接触压力边中比得到调控特性与辊间接触压力之间的具体关系,并结合现场的实际生产数据对仿真分析结果进行验证,研究结果可为现场辊形配置与板形调控提供较好的理论基础和生产指导。     

辊形配置对辊间接触压力与板形调控影响分析

为系统分析不同辊形配置下辊间接触压力分布形式与板形调控特性,以某1 800 mm热轧生产线使用的2种典型辊形配置为研究对象,建立对应的辊系有限元模型,计算不同带钢规格与调控手段下辊间接触压力分布形式,分析得出常规凸度支撑辊对应的辊间接触压力分布形式与CVC工作辊辊形呈现出明显的对应性,且压力分布形式受轧制规格与调控手段的影响明显小于CVC支撑辊。利用接触压力峰值和不均匀度表述辊间接触压力分布特征,将不同规格与调控手段对辊间接触压力分布特征的影响进行量化处理,得到更为具体的不同参量在整个变化范围内对分布特征的整体影响趋势。同时还对2种辊形配置下不同辊间接触压力对轧机板形调控特性影响进行分析,得出CVC支撑辊对应辊形配置的弯辊力与窜辊位置在板形调控能力上均强于常规凸度支撑辊辊形配置,而不同辊形配置对辊缝形状的影响表现出较为明显的差异,引入辊间接触压力边中比得到调控特性与辊间接触压力之间的具体关系,并结合现场的实际生产数据对仿真分析结果进行验证,研究结果可为现场辊形配置与板形调控提供较好的理论基础和生产指导。     

Operation on varicose, especially in the malleolar region (author's transl)

The great number of people with varicosities and the relatively high percentage of venous pathology among this group shows the importance of their detection and treatment. The results achieved in more than 1000 operations on varicose legs underline the great benefits arising from surgical treatment of the varicose saphenous vein. The treatment of chronic venous insufficiency in the malleolar region has been aided by the use of the Klapp tenotoma. The simple and atraumatic manipulation of this instrument enables the surgeon to overcome the most important obstacles in this region, the perforator veins (Cockett I, II), the venous leg ulcer and the corona phlebectatica paraplantaris. Conscientious postoperative supervision of the patient by the surgeon personally or by a dermatologist trained in this speciality is an essential condition for the successful operative treatment of varicose veins.     

Preoperative assessment of primary varicose veins

The first step in the evaluation of a patient with primary varicose veins is a careful personal history and clinical examination. The individual advice should be based on the disturbance suffered due to the actual varicose veins, "heaviness of the legs" and the advantages and disadvantages of various therapies. The aim of an examination in any type of varicose veins is to determine their relationship to the deep and the surrounding superficial venous system. The continuous-wave Doppler method is often sufficient to examine the trunk of the long saphenous vein. Colour-coded duplex sonography is the chosen method for evaluation of the deep venous system with respect to flow feasibility and valve competence, as well as localization of deficient perforants and anatomic variations at the saphenouspopliteal junction. Phlebography is reserved for cases with inconclusive duplex-sonography results or if no duplex is available. The purpose of this exhaustive preoperative evaluation is to indicate in detail the haemodynamic and anatomic situation in the groin and in the popliteal fossa and to detect the relevant insufficient perforators. Such accurate haemodynamic assessment is the basis for an individualized operation with excellent cosmetic and functional results. Whether a reduced recurrence rate after varicose vein surgery can be shown with this extensive examination scheme has not yet been investigated in a prospective study.     

Recurrence of varicose veins after treatment. Multicenter study by the Italian Doppler Club, Clinical and Technological Society

BACKGROUND: The first results of a multicentric study dealing with recurrent varicose veins after surgery are presented. The aims of the study are: identifying the type of varicose vein, specifying the most frequent complaints (esthetical or functional), locating the causes of recurrence, establishing the causes and the most frequent seat of recurrence, clarifying whether it is enough to call recurrent all the varicose veins which appear after surgery or whether it is necessary to distinguish various typologies. METHODS: 194 patients (139 women and 55 men) aged 51.6 average (range 28-87), have been studied up to now with duplex and color scanner following a precise protocol which consisted of three stages: before treatment, within 2 months from treatment and after recurrence of varicose veins or venous insufficiency symptoms. RESULTS: Recurrent varicose veins represented 65.7%, residual ones 14.3%, new ones 2.5%. It has not been possible to identify the type of varicose vein in 8.3% of cases. Stripping of the great saphenous veins was carried out in 88% of cases, short stripping in 4.1%, stripping of the short saphenous veins in 6.9%. Recurrent varicose veins were due to technical error in 78.7% of cases, to diagnostic error in 9.2%, to unidentifiable causes in 12% of cases. CONCLUSIONS: Data relating to the prospective study of the research will be published in subsequent papers.     

Analysis of Roll Gap Pressure in Sendzimir Mill by FEM

The acting force on the roll system of Sendzimir mill was analyzed using 3D FEM.The roll gap pressure distribution and the acting force between rolls S and O,rolls O and I,rolls O and J,rolls I and A,rolls I and B,as well as rolls J and B were analyzed.The results showed that the roll gap pressure mainly affected the roll surface layer,50 mm for backup roll;the roll gap pressure distribution is of double peaks among the work roll,the 1st intermediate roll（IMR）,and the 2nd IMR;the maximum value of the roll gap pressure between the backup roll and the second IMR appears on the edge of the barrel of rolls;the component force presents the in-para-curve distribution.These are important for reducing the wear of rolls and the break of the backup roll and guiding for production.     

宽带钢热连轧机组均压支承辊辊形开发与应用

 CVC工作辊辊形自发明以来在全球150多条热连轧生产线上得到应用,以控制带钢的板形。实际应用中,与CVC工作辊配对使用的支承辊无论采用平辊还是CVC辊形均存在非均匀磨损甚至轧辊剥落失效的问题,主要原因是CVC支承辊辊形和平支承辊与CVC工作辊配置时存在接触压力集中。为了解决此问题,设计并应用了一种均压支承辊辊形与CVC工作辊配置使用。此辊形是变接触支承辊辊形（VCR）与CVC支承辊辊形的组合,具有变接触辊形的优点,同时又能更好地与CVC工作辊配置使用。均压支承辊辊形应用后,改善了CVC工作辊与支承辊辊间接触状态,解决了轧辊剥落问题,并改善了带钢凸度质量。     

Studies on the effect of short-term oral dihydroergotamine and troxerutin in patients with varicose veins

OBJECTIVE: To evaluate the clinical efficacy and pharmacologic effects of dihydroergotamine and troxerutin on varicose veins. METHODS: A double-blind, randomized, placebo-controlled parallel-group study was conducted in 53 patients with primary varicose veins. Patients received either a fixed combination of 3 mg dihydroergotamine and 300 mg troxerutin three times a day or placebo for 3 weeks. Symptomatic improvement was assessed by a self-assessment score, venocontracting effects on a varicose vein were quantified by the venous compliance technique (VCT), and changes in venous dysfunction were measured by digital photoplethysmography (DPPG). RESULTS: A significant reduction (p < 0.01) of subjective symptoms was observed in both groups. Results from VCT and DPPG after the therapy with dihydroergotamine and troxerutin or placebo were not significantly different (p > 0.05) from pretreatment values. Furthermore, no significant intergroup difference was observed when the before- and after-therapy differences of values of the self-assessment scores (VCT and DPPG) were compared. CONCLUSION: In our study, 3 weeks of treatment with a fixed drug combination of 3 mg dihydroergotamine plus 300 mg troxerutin three times a day had no measurable effect compared with placebo on any of the evaluated end points.     

i(5p) and del(6q) are nonrandom abnormalities in carcinoma cervix uteri. Cytogenetics of two newly developed cell lines

BACKGROUND: It is impossible to treat all varicose veins employing the same method. Cryosurgery offers a new modality for the detraction of the long and short saphenous vein deletion. OBJECTIVE: To describe the technique, its indications, potential complications, and cosmetic results. METHODS: We followed 800 patients over 6 years. The study allows evaluation of the results of and the best indications for this method. With a follow up of five years, we have analyzed: 1) the immediate complications, and 2) middle-term results. RESULTS: The results of cryosurgery of varicose veins were generally comparable to those obtained using classical surgery (stripping). CONCLUSION: Cryosurgery of varicose veins is a fast and safe method for selected varicose disorders, exhibiting good cosmetic results.     

六辊冷连轧机中间辊横移过程辊间接触压力分析

 为了使轧机板形控制性能适应带钢规格材质变化,用于连续轧制高档冷轧薄带钢的六辊冷连轧机大都采取中间辊可横移技术。但是,中间辊横移必定使辊间接触压力分布更不均匀,导致出现接触压力尖峰。在中间辊横移过程中,辊间接触压力和横移阻力都会随横移速度的变化而发生改变,并可能导致辊间接触压力在轧辊端部形成更大的压力尖峰,从而造成轧辊磨损不均匀并缩短轧辊的使用周期。通过建立有限元仿真模型,以仿真模拟获得中间辊横移过程中辊间接触压力的变化规律后,优化设计轧辊辊形,并且提出使用非对称弯辊力的方法,实现了辊间接触压力的分布均匀化,降低了辊间接触压力尖峰值,并延长了轧辊的使用寿命。     

Stress-induced sleep deprivation modifies corticotropin releasing factor (CRF) levels and CRF binding in rat brain and pituitary

OBJECTIVE: Mast cells are suggested to play an essential role during development of varices in the lower limbs. EXPERIMENTAL DESIGN: Investigation of the ultrastructure of mast cells in varicose lesions. SETTING: Saga Medical School, Yamamoto Surgical Hospital. PATIENTS: Eighteen varicose veins of 17 patients and 9 normal saphenous veins of 9 patients were examined. Patients who had undergone sclerotherapy for varices were excluded. INTERVENTIONS: Radical stripping surgery was performed on all varicose veins. MEASURES: Ultrastructural observations. RESULTS: In normal saphenous veins, mast cells usually singly embedded in dense collagen bundles as resident cells. They have characteristic crystalline granules of storage type. In varicose veins, mast cells show different features such as an increase of altered granules of discharging type, degranulation and intimate relationship with fibroblasts and lymphocytes. CONCLUSIONS: The observations suggest the presence of mast cell-mediated mechanism by releasing some mediators in the development of varices.     

Temperature and thermal stresses in work rolls during the hot rolling of strip

In this paper the solution of the unsteady, three-dimensional heat transfer in work rolls was derived by using Bessel functions and the δ-function and expressed by an infinite series. In this manner other problems of heat transfer in solid cylinders and hollow cylinders can also be calculated. The temperature profile of the work roll due to the distribution of the temperature in the axial direction can cause unregular pressure distribution between work roll and backup roll and can influence the quality of strip. Therefore, the thermal crowns must be considered at various moments during rolling. The thermal crown can be determined by using the FE-Method or others. The reason for the fire-cracking in the roll surface can be determined as the thermal shock load in the contact zone, in which the sharp compressive stresses lead to local plastic deformation. The local plastic deformations are followed by residual deformations. Therefore, residual tensile stresses occur in the cooling zone. On each revolution, the surface undergoes plastic strain in compression and in tension. The result is thermal fatigue. The fine network of cracks in the roll surface can result in a sharp stress concentration which is dangerous for the rolls loaded with a bending moment. The maximum tensile stresses due to the temperature distribution occur in the roll core, which usually do not lead to damages of the rolls.     

HC轧机辊型曲线优化

HC轧机采用中间辊轴向窜动技术,使轧机的横向刚度显著增加,提高了板形控制能力。但由于中间辊轴向窜动后,在工作辊与中间辊、中间辊与支撑辊间形成接触压力峰值,导致轧辊局部磨损及带材表面质量问题。建立了HC轧机板形和断面形状计算模型,研究了支撑辊及工作辊辊型曲线对辊间接触压力分布的影响规律,在此基础上优化了1220HC轧机支撑辊及工作辊辊型曲线。理论计算及工业生产试验表明,在保证轧机板形控制能力前提下,在HC轧机支撑辊及工作辊上采用合适的辊型曲线,可将支撑辊与中间辊间的接触压力峰值降低20%以上,将工作辊与中间辊间的接触压力峰值降低10%以上,从而避免辊间接触压力峰值带来的轧辊局部磨损及相应的带钢表面质量问题。