[Who will get leg ulcers, how can recurrence be avoided?].
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Adult↗
Biomedical subjects
A Cornu-Thénard
Publications and source records attributed to A Cornu-Thénard.
Results of a questionnaire regarding improvement of 'C' in the CEAP classification.
BACKGROUND: One of the shortcomings of the CEAP classification is that some of the clinical conditions in the original version were not defined and, therefore, were used in different ways by those who work with CEAP. AIM: To clarify the definitions of the seven clinical classes in the CEAP classification and to improve universal understanding of these in phlebology. METHODS: The authors prepared a short questionnaire regarding the 'C' part of CEAP with five main questions, dealing with definitions of clinical items: telangiectases, corona phlebectatica, reticular veins, varicose veins and the use of CEAP. The questionnaire was translated into 11 different languages and sent around the world by means of International Venous Digest by fax. Two hundred and six answers were received from 67 countries out of 3681 faxes sent (5.6%). RESULTS: There were a wide variety of opinions returned thus demonstrating that the same term is used with various meanings by different physicians. All physicians classify telangiectases of thigh and foot as class C1, but discrepant answers were obtained concerning the differences between reticular veins and reticular varicose veins as well as the diameter of small and large varicose veins. Sixty per cent of physicians answering this survey use the CEAP classification. CONCLUSION: Further clarification and refinement of the CEAP classification are necessary. The authors hope that this will result in broader acceptance of CEAP.
Humans↗
Do we need a better classification than CEAP?
The CEAP classification, C Clinical, E Etiology, A Anatomy and P Pathophysiology, corresponds to the four main headings of chronic venous disease. Each heading is composed of clearly defined subheadings. This classification is therefore complete and well structured and, as a result of this innovation, far superior to previous classifications. On the other hand, this classification is complex and difficult to use for many clinicians. It also lacks a whole series of important items, such as vascular history, corona phlebectatica, widely used in Europe, and a varicose veins score. More complete and more rigorous studies could be conducted if these items were included under the "C" heading. A number of improvements have been proposed over recent years. They are designed to simplify the CEAP, without introducing any structural changes. The scientific justification for these simple modifications would be an improvement of the coherence. However, these proposals must be validated before being presented to the American Venous Forum. One of the most recent proposals is the development of computer software which would considerably facilitate the use of this classification. Further studies are necessary to demonstrate the value of these modifications.
Chronic Disease↗
[Support and compression of the legs].
Physical methods are essential in the treatment of venolymphatic insufficiency. The available materials have two modes of action, support and compression; they may be used alone or in association. Clinical experience and a few scientific works formed the basis for establishing protocols adapted to each situation. Like any major treatment, these should be under the full responsibility of physicians. Prescriptions should be precise and, in particular, evaluated for each patient by the physician himself.
Bandages↗
Evaluation of different systems for clinical quantification of varicose veins.
One hundred twenty-five lower limbs with varicose veins were studied clinically, essentially by palpation. Two specialists in venous pathology scored the severity of the varicose veins from 0 to 20. Comparison between the different clinical parameters and the scores of the specialists showed that two systems of clinical quantification gave good results and were easy to use. One system is the maximum diameter of the largest varicose vein; the other system is the sum of maximum diameters over 7 sections (3 for thigh, 3 for leg, 1 for foot). This latter system gives a more precise evaluation of the clinical severity of the varicose veins.
Adult↗
[Evaluation of the results of the curative treatment of varices using 3 scoring systems: clinical, Doppler and echographic].
There have been many studies reporting results of curative treatment of varicose veins. Four methodological errors are nevertheless often committed: groups of varicose vein patients not comparable with regard to the degree of venous dilatation; insufficient objective parameters; population inadequately followed up; retrospective studies. It was felt necessary to develop systems for the quantification of varicose disease. These systems provide three grades: a clinical grade, a Doppler grade and an ultrasonographic grade. Clinical grade essentially involves the maximum diameter of varicose veins found by palpation and expressed in millimetres. The Doppler grade takes into account the maximum duration of the reflux wave in compression-decompression manoeuvres. The ultrasonographic grade also involves the maximum diameter of the varicose system. These grades enable the numerical assessment of the results of curative treatment of varicose veins, as well as forming the basis for statistically satisfactory epidemiological surveys.
Combined Modality Therapy↗
Measuring units for elastic stockings: priority to mmHg rather than classes.
Seven incontrovertible arguments show that the only valid measurement unit for elastic stockings is the millimetre of mercury and not a grading system. The mmHg is an international measurement unit; a new European grading system will make prescribing much more difficult; the degree of arterial insufficiency is calculated by taking systolic pressures by Doppler and is expressed in mmHg; in case of superimposition of elastic stocking, pressure add together but not grades; the unit used for pressure instruments is the mmHg; a clinical situation may require a compression force straddled between two grades; finally, new materials will certainly provide increasingly precise forces.
Bandages↗
[Pressure therapy using elastic stockings].
Elastic stockings raise problems of two types: prescribing for the physician and compliance for the patient. The prescription must contain five pieces of information: the name of the stocking, its compression strength, its size, its height and its length. Compression strength should be noted either in mmHg, corresponding to the type of disease requiring treatment, or directly in terms of the suffix of the stocking. A table listing the majority of elastic stockings available in France and showing their compression strength facilitates prescribing. It is equally important to take the time to convince each patient of the value of this type of compression, to review the technical difficulties associated with the putting on and taking off of the stockings and the possibilities of superimposition. Compliance with prescribed treatment is the key to success.
Bandages↗
[Left predominance of varices: myth or reality?].
The study of 843 legs operated for major varices shows that they are equally distributed between the two lower limbs (48.6% on the right, 51.4% on the left). There is little sex-determined variation in this distribution (410 women - 184 men), the main difference being that found in men: +4.6% on the left. Other studies carried out in Europe come to much the same conclusion. Two of these studies do, however, note a much clearer predominance of left-leg varices in men (+10%). For some studies, the lack of information about the type of varices being considered has proved troublesome (for example the many isolated telangiectasis and varices) and means that it is impossible to come to any exact conclusion. Clinical quantification is therefore desirable: at least it takes into account the diameter of the varices studied.
Adolescent↗
[Attempt at quantification of the clinical picture of varices for epidemiologic, therapeutic and data-processing purposes].
The expression "presence of varices" does not mean it is possible to anticipate their importance. The use of qualifications such as large, average or small by no means solves the problems of their evaluation for they often take on a different meaning according to the interpretation of the observer. The authors suggest the use of a system of clinical evaluation whose chief characteristic is the measurement of the diameter of varices. In the field of epidemiological studies, quantification is subjected to the determination of a coefficient of maximal invasion (CMI). This is equal to the product of the maximal diameter (MD) of the varices present, by their total length (TL). CMI = MD X TL. The clinical quantification for therapeutics, that is, the quantification that can be used in daily practice, is more simple. It is achieved by the intermediary of three parameters the maximal diameter, the maximal number and height of the varices present in each area. The regular analysis of these three variables makes it possible to follow in figures, and therefore in a way which is readily transmissible, the mode of evolution of the varicose disease. Generally, this quantification completes the usual schemas, makes the teaching of sclerotherapy much easier, makes phlebology more accessible for computer data, with cartography as a basis for the anatomical reference points. The main interest in these two systems lies in the use of a simple language which can be easily understood by everyone, whatever their nationality, and this makes for a more exact appreciation of the work that has been carried out and results in much better communication.
Electronic Data Processing↗