[Popliteal artery entrapment syndrome]. / Syndrome de l'artère poplitée piégée.

Popliteal entrapment is a rare compression syndrome involving vascular (and neurologic) structures of the popliteal fossa. In this article we review the popliteal artery entrapment syndrome (PAES). PAES is a cause of intermittent claudication that can be, although rarely, complicated with acute limb-threatening ischemia. PAES occurs more often in young adult. Concerning pathophysiology, PAES is provoked by an abnormal relationship between popliteal artery and muscular-tendon structures within the popliteal fossa. A surgical repair is usually required to resolve mechanical compression or vascular damage.

[Management of post-thrombotic syndrome]. / Prise en charge du syndrome post-thrombotique.

Post-thrombotic syndrome (PTS) is the most frequent chronic complication of deep vein thrombosis with an estimated prevalence of 30-50%. PTS is a significant cause of disability, especially when complicated by venous ulcers. Therefore, it has important socio-economic consequences for both the patient and the health care system. Aim of this review is to resume state of the art literature on the management of PTS.

[Vascular rehabilitation of patients suffering from peripheral arterial disease]. / Rééducation vasculaire du patient artériopathe.

Rehabilitation programs represent an important and valuable tool for patients suffering various diseases. Supervised exercise programs for patients with peripheral arterial diseases have been shown to be efficacious in ameliorating walking performances and quality of life of such patients. With this regards the angiology service of the CHUV in Lausanne has established a multidisciplinary supervised program of vascular rehabilitation. This article describes organisation and characteristics of such a program.

[Prevention of post-thrombotic syndrome]. / Prévention du syndrome post-thrombotique.

Post-thrombotic syndrome (PTS) is the most frequent chronic complication of deep vein thrombosis (DVT) with an estimated prevalence of 30-50%. PTS is a significant cause of disability, especially when complicated by venous ulcers. Therefore, PTS has important socio-economic consequences for both the patient and the health care system. Actually, the efficacy of PTS treatment is very limited; therefore, best treatment remains prevention. Compression therapy, particularly by graduated compression stockings (GCS) has a pivotal role in PTS prophylaxis. Aim of this article is to resume state of the art literature on this subject. Recommendations on PTS prevention have even been reported.

[Superficial vein thrombosis: what's new in the management?]. / Thrombose veineuse superficielle: quelles nouveautés dans la prise en charge?

Lower limbs superficial venous thrombosis (SVT) is a relatively frequent disease. Its prevalence among patients consulting their treating physician is estimated to be 10.8% among women and 4.9% among men. Up to 25% of at risk patients with isolated SVT present with a concomitant DVT. Ultrasound imaging may play a role in the management of these patients allowing precise diagnosis, determination of thrombus extension and presence of associated DVT. From data recently appeared in the literature treatment of SVT with prophylactic doses of fondaparinux may be proposed to at risk patients with isolated SVT.

[Venous thromboembolism and neoplasms]. / Tromboembolismo venoso e neoplasia.

Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, is a major cause of morbidity and mortality. In most cases, one or more risk factors for removable or persistent venous thromboembolism can be identified. Persistent risk factors include inherited or acquired abnormalities of the hemostatic system and cancer. As Armand Trousseau first suggested, venous thromboembolism may be the first clinical manifestation of an occult cancer. This relationship has recently been confirmed by methodologically well designed studies. Furthermore, venous thromboembolism is the second cause of death in patients with clinically overt cancer. This review summarizes the state of the art of this association. The clinical trials described focus on the need to perform screening for occult cancer in patients with idiopathic venous thromboembolism. How extensive this screening should be is still matter of debate. On the other hand, patients with clinically overt cancer should be considered at high risk for developing venous thromboembolism, and adequate prophylaxis should be used.

Antibody response to 1995-1996 influenza vaccine in institutionalized and non-institutionalized elderly women.

BACKGROUND: Concern about poor responsiveness to influenza vaccination by institutionalized elderly people. OBJECTIVE: To determine whether institutionalized elderly volunteers develop a significant antibody response following influenza vaccine and to compare this response with that of non-institutionalized subjects. METHODS: The haemagglutination-inhibiting antibody response after 1995-1996 influenza vaccination [A/Shangdong/9/93 (H3N2), A/Taiwan/1/86 (H1N1), B/Panama/45/90] was estimated in 80 elderly women living in a nursing home and compared with that of 51 non-institutionalized women. RESULTS: No differences were found in the prevaccination status, and, after vaccination, a significant humoral response was elicited both in institutionalized and non-institutionalized elderly subjects against all three influenza strains tested. The immune response of institutionalized patients was satisfactory and significantly higher than that observed in non-institutionalized women. These results were confirmed both by a separate analysis of homogeneous subgroups stratified according to the presence in the two cohorts of potential causes of differential antibody response (prevaccination antibody titre, age, long-term drug treatment, risk factors for influenza infection, and physical disability) and by logistic regression analysis in order to adjust immune responses for the different variables. CONCLUSION: Influenza vaccination is effective in elderly people living in nursing homes. However, the postvaccination antibody response to influenza vaccine is influenced by different factors directly or indirectly related to residence.

The post-thrombotic syndrome in young women: retrospective evaluation of prognostic factors.

Post-thrombotic syndrome (PTS) in young women may cause impairment in the quality of life of otherwise healthy people. We aimed to evaluate the prevalence of PTS and its risk factors in young women. We evaluated 51 women with at least one previous episode of symptomatic, objectively documented deep vein thrombosis (DVT) before the age of 40. Each patient asked for symptoms had a physical examination, a color-coded Doppler ultrasonography of the superficial and deep venous system and an extensive laboratory evaluation for the congenital and acquired coagulation abnormalities predisposing to thrombosis. The median follow-up was 47 months. PTS was absent in 37%, mild in 55%, moderate in 4% and severe in 4% of patients. No correlation was found between PTS and the presence of coagulation abnormalities, triggering factors, recurrences, use of elastic stockings for one year after DVT, degree of recanalization, presence of superficial reflux. Patients with a body mass index (BMI) >22 had an adjusted ratio of 4.7 (98 CI: 1.0-23.3) of developing the PTS. Though severe and moderate PTS are rare, mild PTS is present in the majority of young women after DVT. A BMI >22 is associated to the risk of developing PTS. Attempt to control weight in women after DVT should be considered and studied to prevent PTS.

Venous thromboembolism after laparoscopic surgery: two case reports and review of the literature.

Two cases of deep vein thrombosis and pulmonary embolism in patients who had undergone laparoscopic surgery (cholecystectomy and inguinal hernioplasty in the first and crural hernioplasty in the second) are described. These cases suggest that prophylaxis for venous thromboembolism should also be given to patients who undergo relatively noninvasive surgery such as laparoscopic intervention. The presentation concludes with a review of the last 7 years' literature on this topic.

[Bilateral aneurysm of the common iliac vein: a case report]. / Aneurisma bilaterale della vena iliaca commune: descrizione di un caso clinico.

Vein aneurysm is a rare encountered lesion. We describe a case of extensive bilateral iliac vein aneurysm as an accidental finding during abdominal ultrasonography of a 39-year-old male marathon runner. Common iliac vein dimensions were respectively: right 39 x 42 x 60 mm and left 43 x 55 x 73 mm, with no signs of thrombosis or spontaneous echocontrast; mean flow velocity was 0.10 m/s with normal dynamics of venous flow. Furthermore we observed abnormal dilatation of the cava vein as well as the common femoral and popliteal veins. Other venous districts, detectable by color-Doppler ultrasound were normal. Known congenital or acquired conditions predisposing to aneurysm and/or ectasia were not detected.

Immunogenicity of influenza vaccine (1993-94 winter season) in HIV-seropositive and -seronegative ex-intravenous drug users.

The humoral response (haemagglutination inhibiting antibodies) to trivalent split influenza vaccine for the 1993-94 winter season (A/Beijing/32/92 (H3N2), A/Singapore/6/86 (H1N1) and B/Panama/45/90) was evaluated in a group of young HIV-seropositive ex-intravenous heroin users and compared with responses measured in HIV-seronegative individuals with a similar history. HIV-negative volunteers showed an overall positive response suggesting that previous heroin use did not influence their humoral response to influenza vaccine. Comparable results were obtained in HIV-positive subjects with CD4+ lymphocyte counts > 500 microliters-1, whereas impaired reactivity was found in HIV-positive volunteers with CD4+ counts < 500 microliters-1. Booster vaccination did not increase antibody levels in any of the groups studied, although the data did not exclude a positive influence of a second vaccine dose on persistence of antibody at 120 days after the first dose. No significant changes were observed in p24 antigenemia levels in HIV-positive individuals after vaccination.

Possible correlation between low antigenic drift of A(H1N1) influenza viruses and induction of HI antibodies.

This study examined whether, during a seven-year period of low A(H1N1) influenza virus antigenic drift (1988-1989 and 1994-1995, winters), humoral antibody response of elderly volunteers to influenza vaccines could suggest a lack of antibody pressure for drift. In all the years studied A/Taiwan/1/86, the A(H1N1) vaccine component, had a low ability to induce protective hemagglutination-inhibiting (HI) antibody titres (> or = 1:40). However a similar low immunogenicity was found for some of the different A(H3N2) strain variants of influenza virus, co-circulating in the same period and showing a regular extent of antigenic variations. Although our data could be at least in part explained by the type of study population (elderly and repeatedly vaccinated), postepidemic serological studies did not evidence a consistently lower ability in mounting protective immune response in elderly people as compared with younger against the influenza strains studied. Therefore, our present results did not exclude a true low immunogenicity of A/Taiwan and of some A(H3N2) influenza strains, circulating in the winters examined. This suggests that, besides the necessity to evade prior immunity, additional factors could influence the frequency of influenza viruses antigenic drifts.

Plasma thrombin neutralization assay: pharmacokinetic applications.

UFH and its derivatives, LMWHs, are effective and safe in the prevention and treatment of DVT. The mechanism for this effectiveness has been difficult to explain, given that the anti-IIa activity of LMWHs is important for their antithrombotic activity and the reported half-life of the anti-IIa activity of LMWHs is very short. The standard chromogenic anti-IIa assay is performed in an artificial system consisting of highly diluted plasma to which antithrombin III is added. It is possible, therefore, that the apparently short half-life of the anti-IIa activity is dependent on the limitations of the anti-IIa assay, commonly used in the pharmacokinetic studies. We have developed an anti-IIa assay that is more sensitive than the standard one. Our assay is based on the ability of UFH or LMWHs to catalyze the formation of TAT complexes. PTNA was able to detect in vitro the anti-IIa activity produced by 0.01 anti-Xa IU/mL of UFH or 0.05 anti-Xa IU/mL of LMWHs. Ex vivo, it was able to describe the time course of plasma anti-IIa activity of very low doses of UFH (intravenous or subcutaneous) or LMWHs. To characterize better the role of the anti-IIa activity of LMWHs, the pharmacokinetic properties of two of these agents have been evaluated in humans, assessing the anti-IIa activity by PTNA. Fraxiparine, 7500 and 10,000 ICU, and Enoxaparine, 20 and 40 mg, were administered subcutaneously to six healthy volunteers.(ABSTRACT TRUNCATED AT 250 WORDS)