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  • 1
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les malades qui présentent une aplasie valvulaire veineuse voit celle-ci ignorée et leurs symptômes mal interprétés car ils sont attribués à une thrombose veineuse profonde. Cet article passe en revue la littérature et apporte des données sur l'étiologie, la symptomatologie, et l'aspect phlébographique de cette affection. Une expérience personnelle de 10 cas a été centrée sur les résultats cliniques et physiologiques obtenus par la compression et le traitement chirurgical de l'insuffisance veineuse superficielle. La compression par un tourniquet ou par un bas compressif n'améliore pas la fonction de pompe des muscles ou le reflux veineux ainsi qu'en témoigne la volumétrie du pied et l'hypertension veineuse n'est pas modifiée. Néanmoins aucun patient n'a développé un ulcère de jambe lors de l'emploi des bas compressifs. L'ablation chirurgicale des veines saphènes incompétentes, des perforantes et des varicosités chez 6 malades (8 membres) a été suivie d'une amélioration de la fonction de la pompe musculaire et d'une diminution de l'hypertension veineuse qui persistait encore 4 ans après une intervention. Un malade seulement a été candidat à la reconstruction du système veineux profond à l'aide d'un transplant de veine axillaire contenant une valve et remplaÇant la veine poplitée mais l'opération est trop récente pour que son résultat puisse Être apprécié. Nos constatations démontrent que la compression est un élément thérapeutique de grande valeur pour traiter l'aplasie vaivulaire veineuse congénitale. Le traitement chirurgical de l'insuffisance veineuse superficielle procure une amélioration de longue durée de la fonction de pompe des muscles et de l'hypertension veineuse. La transplantation de veine valvulée a visée curative et la transposition ne s'appliquent qu'à un petit groupe de malades.
    Abstract: Resumen Los pacientes con aplasia valvular venosa congénita con frecuencia son motivo de diagnóstico equivocado y sus síntomas indebidamente interpretados como el resultado de episodios previos de trombosis venosa profunda. El presente artículo revisa la literatura y suministra datos relativos a la etiología, sintomatología, y apariencia flebográfica en la aplasia congénita valvular venosa. Una experiencia personal con 10 casos fue enfocada hacia el estudio de los resultados clínico fisiológicos con terapia compresiva y el tratamiento quirÚrgico de la insuficiencia venosa superficial. El soporte compresivo con torniquete o media elástica no mejoró la función de bombeo muscular ni el reflujo venoso a juzgar por la volumetría pédea, ni tampoco modificó la hipertensión venosa. Sinembargo, ninguno de los pacientes desarrolló Úlceras de las piernas mientras hubo el uso consistente de medias elásticas compresivas. La resección quirÚrgica de las venas safenas incompetentes, de las perforantes, y de las várices en un subgrupo de 6 pacientes (8 extremidades) resultó en mejoría de la función de bombeo muscular y disminución de la hipertensión venosa, lo cual ha persistido por 4 años postoperatorios. Sólo un paciente ha sido condicionado para reconstrucción venosa profunda con trasplante de un segmento venoso portador de válvula de la vena axilar a la vena poplítea, pero el resultado de este procedimiento es todavía demasiado temprano para ser valorado. Nuestros hallazgos demuestran que la terapia compresiva consistente es de importancia capital en el manejo de pacientes con aplasia valvular venosa congénita. El tratamiento quirÚrgico de la insuficiencia venosa superficial provee mejoría prolongada de la función de bombeo muscular y de la hipertensión venosa. El trasplante o la transposición “curativa” de válvulas venosas es posible apenas en una minoría de este grupo de pacientes.
    Notes: Abstract Congenital vein valve aplasia is often misdiagnosed and its symptoms misinterpreted as being caused by previous deep venous thrombosis. The present article reviews the literature providing data on etiology, symptomatology, and phlebographic appearance in congenital vein valve aplasia. A personal experience with 10 cases focuses on the clinico-physiological results with compression therapy and surgical treatment of superficial venous insufficiency. Compressive support with a tourniquet or a compressive stocking did not improve muscle pump function or venous reflux, as assessed by foot volumetry, and venous hypertension was not affected. Nevertheless, no patient developed leg ulcers during consistent use of compressive stockings. Surgical removal of incompetent saphenous veins, perforators, and varicosities in a subgroup of 6 patients (8 limbs) was followed by an improved muscle pump function and decreased venous hypertension which persisted 4 years post-operatively. Only 1 patient has been suited for deep venous reconstruction with transplantation of a valve-containing vein segment from the axillary vein to the popliteal vein, but it is still too early to assess the results of this procedure. Our findings demonstrate that consistent compressive therapy is paramount in the management of patients with congenital vein valve aplasia. Surgical treatment of the superficial venous insufficiency provides a long-lasting improvement of muscle pump function and venous hypertension. “Curative” vein valve transplantation or transposition is possible only in a minority of these patients.
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  • 2
    ISSN: 1619-7089
    Keywords: Pulmonary ; Glucose metabolism ; Humans
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Regional pulmonary glucose metabolism (MRglu; μmol h−1 g−1), extravascular lung density (DEV; g cm−3) and vascular volume (VB; ml cm−3) were measured in a single midthoracic transaxial slice (≈2 cm thick) using positron emission tomography (PET) in seven patients with histologically proven sarcoidosis. The measurements were repeated 1–7 months later after steroid therapy (in two cases, no treatment) in order to assess MRglu as an index of inflammation and relate it to routine pulmonary function tests, chest radiography and serum angiotensin converting enzyme (SACE) levels. MRglu was computed from serial lung scans and peripheral venous blood samples for 60 min following an i.v. injection of18F-2-fluoro-2-deoxy-D-glucose (18FDG). Both MRgu (which was increased in six of seven patients) and elevated SACE levels returned to normal in those patients treated with high-dose steroids. Regional vascular volume was normal in six of seven cases and did not change significantly with therapy. The high tissue density measured in all patients decreased significantly in two of three patients treated with 40 mg prednisolone daily. The abnormal MR& observed in active sarcoidosis becomes normal pari passu with SACE levels during high-dose steroid therapy. We conclude that MRglu measured with18FDG and PET may reflect “disease activity” in sarcoidosis in quantitative terms (per gram lung tissue) and in respect of disease distribution.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1619-7089
    Keywords: Pulmonary ; Glucose metabolism ; Humans
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Regional pulmonary glucose metabolism (MRglu; μmol h−1 g−1), extravascular lung density (DEV; g cm−3) and vascular volume (VB; ml cm−3) were measured in a single midthoracic transaxial slice (≈2 cm thick) using positron emission tomography (PET) in seven patients with histologically proven sarcoidosis. The measurements were repeated 1–7 months later after steroid therapy (in two cases, no treatment) in order to assess MRglu as an index of inflammation and relate it to routine pulmonary function tests, chest radiography and serum angiotensin converting enzyme (SACE) levels. MRglu was computed from serial lung scans and peripheral venous blood samples for 60 min following an i.v. injection of 18F-2-fluoro-2-deoxy-D-glucose (18FDG). Both MRgu (which was increased in six of seven patients) and elevated SACE levels returned to normal in those patients treated with high-dose steroids. Regional vascular volume was normal in six of seven cases and did not change significantly with therapy. The high tissue density measured in all patients decreased significantly in two of three patients treated with 40 mg prednisolone daily. The abnormal MR& observed in active sarcoidosis becomes normal pari passu with SACE levels during high-dose steroid therapy. We conclude that MRglu measured with 18FDG and PET may reflect “disease activity” in sarcoidosis in quantitative terms (per gram lung tissue) and in respect of disease distribution.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1619-7089
    Keywords: Positron emission tomography ; Regional lung structure ; Structure ; Function relationships
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Positron emission tomography is a major technological advance in the characterisation of structure-function relationships within and between regions in normal and abnormal lungs (Hughes et al. 1985). The measurements are noninvasive and relatively exact since the geometric conditions are precisely defined. Regional expansion, flow (ventilation, perfusion), oxygen concentration (from $${{\dot V_{\text{A}} } \mathord{\left/ {\vphantom {{\dot V_{\text{A}} } {\dot Q}}} \right. \kern-\nulldelimiterspace} {\dot Q}}$$ ) and glucose metabolism can be measured in absolute terms per cubic centimetre of thorax or per gram of extravascular lung. Examples of structure-function relationships in normal subjects, emphysema, bronchitis and sarcoidosis are briefly presented.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1573-7217
    Keywords: breast cancer ; prognosis ; Nottingham histologic grade ; S-phase fraction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Flow cytometric DNA analysis with assessment of S-phase fraction and DNA ploidy was compared to Nottingham histologic grade. The study population consisted of 654 patients who presented between 1987 and 1996 with primary operable breast cancer and whose tumours had been analysed for S-phase fraction and DNA ploidy at the time of surgery. Grade, tumour size, node status, steroid receptor status, age, S-phase fraction and DNA ploidy were analysed univariately and multi-variately in a Cox proportional hazard analysis. In the univariate analyses all parameters were statistically significantly associated with breast cancer mortality during the follow-up period of 2–11 years. The most powerful predictor of death from breast cancer in the multiple regression analysis was grade. Patients with grade 1 tumours have excellent prognosis. We conclude that tumour grade is a strong prognostic indicator applicable to all breast cancer patients, regardless of size and nodal status, and advocate its general use.
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  • 6
    ISSN: 1573-7217
    Keywords: breast cancer ; histopathological grade ; Nottingham Prognostic Index ; prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of this study was to assess the applicability of histopathological grading according to the protocol of Elston/Ellis and the Nottingham Prognostic Index (NPI) to a defined breast cancer population. The NPI is the sum of the individual scores concerning grade, tumour size, and lymph node status, each weighted according to regression coefficients of a Cox proportional hazard analysis and calculated for each individual breast cancer patient. 630 consecutive patients with invasive breast cancer diagnosed 1988–91 were retrospectively followed up and their tumours reviewed and graded. A Cox proportional hazard analysis was performed. Grade, lymph node status, and tumour size were statistically significant predictors of survival within the follow up period (median 7.2 years). Similar to NPI, a temporary index (Kalmar Prognostic Index, KPI) was derived and normalised to NPI for comparison (KPI(norm)). NPI and KPI(norm) gave similar prognostic power in spite of the differences of the patient populations from which the 2 indices were derived. Patients with NPI 4 or less had 0.66% breast cancer specific mortality during the follow up time. 14% of the patients with NPI 4.1–5 and 32% of those with an index sum 5.1–6 died from breast cancer during this time. Younger patients tended to have higher grade tumours. We advocate the common use of grade and the NPI in order to increase the comparability of groups of patients receiving different therapies.
    Type of Medium: Electronic Resource
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