Trends on management of superficial venous disease

Venous disease is more common in the society but less addressed than peripheral arterial disease. This is commonest in people who are sedentary workers, people standing for prolonged period, obase. Usually this group of people do not visit a doctor until it restricts him from regular work, ultimately causing a burden in the community. Early diagnosis of venous disease and its’ management is important. Understanding venous pathology, educating people about disease, conducting awareness program among target group of people are essential. Superficial venous disease includes both venous insufficiency and venous thrombosis. Management options of varicose vein and thrombophlebitis are discussed in the presentation.

Efficacy of Topical Heparin in Prevention of Superficial Thrombophlebitis before Peripheral Venous Cannulation.

Thrombophlebitis can be very commonly associated with peripheral venous cannulation. Many a times, thrombophlebitis may go undiagnosed. With serious complications and uncertainty of the treatment, it is always better to prevent its development. Prophylactic topical heparin application can significantly reduce the incidence of thrombophlebitis and also the complications related like deep venous thrombosis and pulmonary embolism which increase the hospital stay. Thus, this study was conducted to evaluate the efficacy of topical heparin in prevention of development of superficial thrombophlebitis.METHODS150 patients in the age group of 20 - 60 years, were randomly allocated to group H (Heparin), group C (Control), with 75 patients in each group. Group C received placebo (normal saline) and group H received topical heparin QPS before the insertion of the cannula on the dorsum of the upper limb and were observed at an interval of 8 hours until 72 hours using Visual Infusion Phlebitis Scale.RESULTSAt the end of 72 hours, score of 0, I, II, and III was observed in 5.33%, 44.00%, 29.33% and 21.33% patients, respectively, in Group C; whereas score of 0, I, and II was observed in 60%, 25.33%, and 14.67% patients, respectively in Group H (P = 0.0001). In Group C, score up to III was observed, whereas maximum score was II in Group H and that too at 72 h in only 14.67% of patients which proves the efficacy of topical QPS of heparin [Table 2].CONCLUSIONSProphylactic topical application of QPS heparin was effective in preventing development of superficial thrombophlebitis.

The combinative therapeutic effects of Mailuo Shutong Granules and synthetic medications on patients with superficial thrombophlebitis / 中成药

AIM To observe the combinative therapeutic effects of Mailuo Shutong Granules and routine synthetic medications on patients with superficial thrombophlebitis (STP).METHODS Seventy patients randomly and equally divided into control group and observation group were subjected to a two-week conventional treatment and a two-week intervention of Mailuo Shutong Granules on the basis of routine treatment,respectively,and they had the before and after the treatment assessment in terms of main clinical symptoms and signs,endothelial function indices (NO,ET-1,TXB2,6-Keto-PGF1α,VEGF,vWF),hemorheology indices (plasma viscosity,blood sedimentation,erythrocyte aggregation index,fibrous protein).RESULTS The observation group generally demonstrated significantly higher effective rate than the control group (P ＜ 0.05).Markedly decreased post-treatment scores for main clinical symptoms and signs,TXB2,ET-1,vWF,plasma viscosity,blood sedimentation,erythrocyte aggregation index,fibrous protein,and increased 6-Keto-PGF1 α,VEGF and NO (P ＜ 0.05) in both groups were observed,as well as the between-group variance showing the observation group's priority (P ＜ 0.05).The respective 8.57％ and 14.29％ incidence rates of adverse reactions in the observation group and control group were also noticed.CONCLUSION For patients with STP,a combination therapy of Mailuo Shutong Granules on the basis of synthetic medications contributes to an effective main clinical symptoms alleviation due to its vascular endothelial cells protection,cellular secretion function and hemorheological improvement.

Tromboflebitis de Mondor del pene tras hernioplastia inguinal / Mondor's thrombophlebitis of the penis after inguinal hernioplasty

Paciente de 22 años de edad con antecedentes de salud. Hacía un mes se le había practicado una hernioplastia inguinal izquierda, y aproximadamente dos semanas después, comenzó a presentar aumento de volumen y dolor en el dorso del pene, tanto al tacto como con la erección. Al examen físico se constató, que la vena dorsal superficial del pene estaba aumentada de volumen, de color rojizo y dolorosa a la palpación. En el ultrasonido doppler-color peniano, se comprobó el engrosamiento de la pared de dicha vena, trombosis de esta, disminución del flujo sanguíneo, así como dolor al contacto del transductor. Se le indicó reposo sexual, tratamiento con antiinflamatorios no esteroideos y corticoides orales, además de iontoforesis local con pomada de heparina sódica. El paciente evolucionó satisfactoriamente, con la desaparición del dolor y la recanalización de la vena dorsal del pene. La aparición de la tromboflebitis de Mondor del pene, con posterioridad a una hernioplastia inguinal, es excepcional. Su sospecha clínica más la confirmación con el ultrasonido doppler-color, son pilares básicos para el diagnóstico de certeza. El tratamiento conservador ofrece óptimos resultados.

A male patient aged 22 years with a history of health problems. One month before, he had undergone left inguinal hernioplasty, but two weeks after surgery, he began suffering pain in the back of the penis together with increased volume, both on touch and at erect state. The physical examination revealed that the superficial dorsal vein of the penis was more swollen, red-colored and painful on palpation. Doppler-color ultrasound of the penis confirmed thickening of the vein wall, thrombosis, lower blood flow and patient's feeling of pain when the transducer touched it. He was prescribed non-steroidal anti-inflammatory drugs plus oral corticosteroids, cessation of sexual intercourse, in addition to local ionphoresis with sodium heparin ointment. The patient's progression was satisfactory since pain disappeared and the dorsal vein of the penis was re-canalized. Mondor's thrombophlebitis of the penis rarely occurs after inguinal hernioplasty. Clinical suspicion plus Doppler-color US confirmation are basic pillars for a correct diagnosis. The conservative treatment offers optimal outcomes.

Doença de mondor em cirurgia estética de mama / Mondor's disease in aesthetic breast surgery

Introdução: A doença de Mondor é descrita como um processo inflamatório raro, benigno e autolimitado que acomete os vasos tóraco-abdominais. São vários os fatores predisponentes e entre eles a cirurgia de mama é um dos mais frequentes. Relado de Caso: O objetivo do trabalho é descrever um caso típico e tecer considerações quanto ao tratamento, após breve revisão bibliográfica, para que sejam evitados procedimentos desnecessários.

Introduction: Mondor's disease is a rare, benign, and self-limiting inflammatory condition that affects the thoracoabdominal vasculature. Among the several predisposing factors of this disease, breast surgery is one of the most frequent. Case Report: The aim of this work was to describe a typical case of Mondor's disease and to discuss treatment options based on a succinct literature review, so that unnecessary procedures can be avoided in the future.

Mondor's Disease after Operation for Axillary Osmidrosis: A Case Report

Mondor's disease is a benign, self-limited process with spontaneous resolution, which is frequently caused by breast surgery, such as axillary lymph node dissection. We present a case of Mondor's disease that occurred after an axillary osmidrosis operation, which is a less invasive procedure; Mondor's disease may be considered as a possible postoperative complication following an axillary osmidrosis surgery.

Tromboflebite superficial: epidemiologia, fisiopatologia, diagnóstico e tratamento / Superficial thrombophlebitis: epidemiology, physiopathology, diagnosis and treatment

A tromboflebite superficial de membros inferiores é doença de ocorrência comum, estando associada a diversas condições clínicas e cirúrgicas. Historicamente considerada doença benigna, devido à sua localização superficial e ao fácil diagnóstico, o tratamento foi conservador durante muito tempo, na maioria dos casos. Entretanto, relatos recentes de freqüências altas de complicações tromboembólicas associadas - 22 a 37 por cento para trombose venosa profunda e até 33 por cento para embolia pulmonar - alertaram para a necessidade de abordagens diagnósticas e terapêuticas mais amplas, visando diagnosticar e tratar essas possíveis complicações. A possibilidade da coexistência dessas e de outras desordens sistêmicas (colagenoses, neoplasias, trombofilias) interfere na avaliação e influencia a conduta terapêutica, que pode ser clínica, cirúrgica ou combinada. No entanto, devido à falta de ensaios clínicos controlados e às incertezas quanto a sua história natural, o diagnóstico e o tratamento da tromboflebite superficial continuam indefinidos. Neste trabalho, foi feita uma revisão da literatura analisando-se a epidemiologia, fisiopatologia e estado atual do diagnóstico e tratamento da tromboflebite superficial.

Superficial thrombophlebitis of the lower limbs is a commonly occurring disease, and it is associated with various clinical and surgical conditions. Historically considered to be a benign disease due to its superficial location and easy diagnosis, its treatment was, for a long time, conservative in most cases. Nevertheless, recent reports of high frequency and associated thromboembolic complications, which vary from 22 to 37 percent for deep venous thrombosis and up to 33 percent for pulmonary embolism, have indicated the need for broader diagnostic and therapeutic approaches in order to diagnose and treat such possible complications. The possibility of coexistence of these and other systemic disorders (collagenosis, neoplasia, thrombophilia) interferes with evaluation and influences therapeutic conduct, which may be clinical, surgical or combined. However, due to a lack of controlled clinical assays as well as to a series of uncertainties regarding its natural history, the diagnosis and treatment of superficial thrombophlebitis remain undefined. A literature review was performed analyzing the epidemiology, physiopathology and current status of the diagnosis and treatment of superficial thrombophlebitis.

Early surgical treatment for primary lower extremity varicose veins complicated by superficial thrombophlebitis / 中国普通外科杂志

Objective To evaluate the effect of early surgical treatment for primary lower limb varicose veins complicated by thrombophlebitis.Methods The clinical date of 42 patients with primary lower extremity varicose veins complicated by thrombophlebitis treated in 4 years were analyzed retrospectively.The CEAP classification was adopted to establish the diagnoses of the all patieats.In the early stage,high ligation and stripping of the varicase veins were performed.After removal of varicose veins and thrombi,both anti-inflammation therapy and anticoagulant therapy were applied.Results All patients made a good recovery.After surgery,3 patients had skin callous and swelling,and 3 patients had foot nerve paresthesia.But,no serious complications,such as deep venous thrombosis or pulmonary embolism,were observed.The was no recurrence during 2 months to 4 years follow-up.Conclusions Early surgical treatment for primary lower limb varicose veins complicated by superficial thrombophlebitis not only has good results but also helps control of deep venous thrombosis and pulmonary embolism,and other serious complications that can result from superficial venous thrombosis.