Radiofrequency induced thermotherapy (RFITT) of varicose veins compared to endovenous laser treatment (EVLT): a non-randomized prospective study concentrating on occlusion rates, side-effects and clinical outcome.

BACKGROUND: Radiofrequency obliteration (RFO) and endovenous laser treatment (EVLT) are established techniques in varicose therapy. A novel bipolar RFO technique - Radiofrequency Induced Thermotherapy (RFITT) - was introduced in 2007. Comparative studies of RFITT and EVLT with one year follow-up are missing. OBJECTIVE: Comparison of RFITT with EVLT concentrating on occlusion, side-effects, and patients' satisfaction in a prospective non-randomized study. METHODS: 133 patients with incompetent GSV or SSV were treated by RFITT (n=66) or EVLT (n=67). Follow-up at days 1, 7, and months 3, 12 included duplex, digital photoplethysmography (DPPG), assessment of VCSS and patients' satisfaction. RESULTS: Both groups were balanced concerning clinical parameters. Occlusion rates were in trend in favour of EVLT (96.9%) vs RFITT (88.9%), p=0.093, at 12 months follow-up. Functional outcome by DPPG (refilling time: 30.8 vs 31.9 sec.), and side-effects were comparable apart from pain in the first postoperative week, which was more frequent in the EVLT group (0 vs 16.4%, p=0.001). Change in VCSS from baseline was advantageous for EVLT (89.9% vs 79.3%, p=0.005). Major complications did not occur. Both techniques provided excellent satisfaction results. CONCLUSION: After one year RFITT is similarly as effective and safe as EVLT treatment of varicose insufficiency, but needs improvement in treatment parameters.

Induction of CD4+ T cell apoptosis as a consequence of impaired cytoskeletal rearrangement in UVB-irradiated dendritic cells.

Low dose UVB irradiation of dendritic cells (DC) dose-dependently decreases their allostimulatory capacity and inhibits alloreactive T cell proliferation. The reduction of the stimulatory capacity is not associated with a perturbation of CD28 costimulation. To examine the underlying mechanism, cell cycle analysis of T cells from cocultures with UVB-irradiated DC (UVB-DC) was performed, revealing no cell cycle arrest, but an increased number of apoptotic T cells in sub-G(0) phase. We confirmed T cells to undergo apoptosis after coincubation with UVB-DC by TUNEL staining and DNA laddering. To analyze whether T cell apoptosis requires the Fas/Fas ligand (FasL) pathway, MLRs were performed with Fas-, FasL-deficient, and wild-type DC and T cells. No differences were found on comparison of wild-type DC with Fas-/FasL-deficient DC or T cells. Likewise, addition of a neutralizing anti-TNF-alpha mAb to cocultures could not overcome inhibition of T cell proliferation by UVB-DC, excluding involvement of the TNF-alpha/TNF-alphaR pathway. FACS analysis of CD69 and CD25 revealed no up-regulation on T cells cocultured with UVB-DC, suggesting a perturbation of early T cell activation. Analysis of UVB-DC by confocal microscopy demonstrated impaired filamentous actin bundling, a process critical for T cell stimulation. To investigate the functional relevance of these observations, time lapse video microscopy was performed. Indeed, calcium signaling in CD4(+) T cells was significantly diminished after interaction with UVB-DC. In conclusion, UVBR of DC impairs their cytoskeletal rearrangement and induces apoptosis in CD4(+) T cells by disruption of early DC-T cell interaction, resulting in a reduced Ca(2+) influx in T cells.