Cellulitis in chronic oedema of the lower leg: an international cross-sectional study.

BACKGROUND: Cellulitis and chronic oedema are common conditions with considerable morbidity. The number of studies designed to assess the epidemiology of cellulitis in chronic oedema is scarce. OBJECTIVES: To investigate the prevalence and risk factors of cellulitis in chronic leg oedema, including lymphoedema. METHODS: A cross-sectional study included 40 sites in nine countries during 2014-17. Adults with clinically proven unilateral or bilateral chronic oedema (oedema > 3 months) of the lower leg were included. The main outcome measures were frequency and risk factors for cellulitis within the last 12 months. RESULTS: Out of 7477 patients, 15·78% had cellulitis within the last 12 months, with a lifetime prevalence of 37·47%. The following risk factors for cellulitis were identified by multivariable analysis: wounds [odds ratio (OR) 2·37, 95% confidence interval (CI) 2·03-2·78], morbid obesity (OR 1·51, 95% CI 1·27-1·80), obesity (OR 1·21, 95% CI 1·03-1·41), midline swelling (OR 1·32, 95% CI 1·04-1·66), male sex (OR 1·32, 95% CI 1·15-1·52) and diabetes (OR 1·27, 95% CI 1·08-1·49). Controlled swelling was associated with a reduced risk (OR 0·59, 95% CI 0·51-0·67). In a subgroup analysis, the risk increased with the stage of oedema [International Society of Lymphology, stage II OR 2·04 (95% CI 1·23-3·38) and stage III OR 4·88 (95% CI 2·77-8·56)]. CONCLUSIONS: Cellulitis in chronic leg oedema is a global problem. Several risk factors for cellulitis were identified, of which some are potentially preventable. Our findings suggest that oedema control is one of these. We also identified that advanced stages of oedema, with hard/fibrotic tissue, might be an important clinical indicator to identify patients at particular risk.

Texture analysis of vertebral bone marrow using chemical shift encoding-based water-fat MRI: a feasibility study.

This feasibility study investigated the spatial heterogeneity of the lumbar vertebral bone marrow using chemical shift encoding-based water-fat MRI. Acquired texture features like contrast and dissimilarity allowed for differentiation of pre- and postmenopausal women and may serve as imaging biomarkers in the future. INTRODUCTION: While the vertebral bone marrow fat using chemical shift encoding water-fat magnetic resonance imaging (MRI) has been extensively studied, its spatial heterogeneity has not been analyzed yet. Therefore, this feasibility study investigated the spatial heterogeneity of the lumbar vertebral bone marrow by using texture analysis in proton density fat fraction (PDFF) maps. METHODS: Forty-one healthy pre- and postmenopausal women were recruited for this study (premenopausal (n = 15) 30 ± 7 years, postmenopausal (n = 26) 65 ± 7 years). An eight-echo 3D spoiled gradient echo sequence was used for chemical shift encoding-based water-fat separation at the lumbar spine. Vertebral bodies L1 to L5 were manually segmented. Mean PDFF values and texture features were extracted at each vertebral level, namely variance, skewness, and kurtosis, using statistical moments and second-order features (energy, contrast, correlation, homogeneity, dissimilarity, entropy, variance, and sum average). Parameters were compared between pre- and postmenopausal women and vertebral levels. RESULTS: PDFF was significantly higher in post- than in premenopausal women (49.37 ± 8.14% versus 27.76 ± 7.30%, p < 0.05). Furthermore, PDFF increased from L1 to L5 (L1 37.93 ± 12.85%, L2 38.81 ± 12.77%, L3 40.23 ± 12.72%, L4 42.80 ± 13.27%, L5 45.21 ± 14.55%, p < 0.05). Bone marrow heterogeneity based on texture analysis was significantly (p < 0.05) increased in postmenopausal women. Contrast and dissimilarity performed best in differentiating pre- and postmenopausal women (AUC = 0.97 and 0.96, respectively), not significantly different compared with PDFF (AUC = 0.97). CONCLUSION: Conclusively, an increased bone marrow heterogeneity could be observed in postmenopausal women. In the future, texture parameters might provide additional information to detect and monitor vertebral bone marrow alterations due to aging or hormonal changes beyond conventional anatomic imaging.

[A new Soviet drug, ethacizine, in the treatment of ventricular rhythm disorders]. / Novyi otechestvennyi preparat étatsizin v lechenii zheludochkovykh narushenii ritma.

The intravenous form of the Soviet anti-arrhythmic pharmaceutical ethacizine has been studied clinically. The pharmaceutical was administered to 30 patients with ventricular rhythm disorders during 3 to 15 minutes, at an average dose of 0.63 mg per 1 kg body weight, under the Holter monitor control. On the average the effect became apparent 6.5 min, after the injection and lasted on the average 149 +/- 15 min. Etacizine was effective in 77% of cases. It was established that there was no pronounced negative effect on the heart rate and the arterial pressure. Uzineg the tetrapolar rheography method it was shown that there was no pronounced negative effect on the central hemodynamics. The observation was made that etacizine induced a moderate decrease of the conductivity in atria AV-system and ventricles. Etacisin could be successfully used for rapid suppression of the ventricle rhythm disorders in various forms of coronary disease of the heart.

[Pharmacokinetic characteristics of lidocaine in patients with circulatory failure]. / Osobennosti farmakokinetiki lidokaina u bol'nykh s nedostatochnost'iu krovoobrashcheniia.

It has been shown with special reference to 35 patients suffering from myocardial infarction, atherosclerotic cardiosclerosis and rheumatic heart diseases associated with varying degrees of circulatory insufficiency that the final amount of distribution and halflife of lidocaine directly correlated with the cardiac index. A formula has been suggested for calculating the amount of distribution of the drug on the basis of the cardiac index. It has been demonstrated that the formula can be used for the development of therapeutically effective lidocaine concentration in the patients' blood.

[Use of phosphaden in treating chronic ischemic heart disease]. / Primenenie fosfadena pri lechenii bol'nykh khronicheskoi ishemicheskoi bolezn'iu serdtsa.

The pharmacodynamics and pharmacotherapy of phosphaden (adenosine-5-monophosphate), a Soviet activator of energy metabolism, were studied in patients with chronic ischemic heart disease. Functional and biochemical methods were used. It was established that phosphaden is an effective drug in the treatment of chronic ischemic heart disease. The results of clinical, functional and biochemical examination support this conclusion.

Dihydroergotoxine: 6-mg versus 3-mg dosage in the treatment of senile dementia. Preliminary report.

In 14 patients with senile dementia, a study was made of two dosage levels (3 mg or 6 mg daily) of dihydroergotoxine mesylate (DEM, Hydergine). Only a nonstatistically significant trend was found for superiority of the higher dosage. However, one patient showed remarkable clinical improvement during the 6-mg period; the mechanism remains unexplained. Further studies are needed with this higher dosage in less impaired patients and in those with well-defined cerebral pathologic changes.