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Biomedical subjects

J C Veraart

Publications and source records attributed to J C Veraart.

At least 19 recordsLinked to original sources
PubMed2004

[Progressive lymphoedema in the legs of children and adolescents].

In three children, two girls aged 18 months and 15 years and a boy aged 16 years, lymphoedema of the legs was diagnosed. Investigation by dynamic lymphoscintigraphy showed no or diminished activity of lymph vessels in the lower extremities. The patients were treated by manual compression therapy and compression stockings, which controlled the oedema. Early recognition and diagnosis are important, as otherwise irreversible complications and reduced mobility may occur.

Adolescent↗
PubMed2000

The effect of medical elastic compression stockings with different slope values on edema. Measurements underneath three different types of stockings.

BACKGROUND: Medical elastic compression stockings are widely used in venous diseases. Their effects on the venous system have been shown in the past. Up to now, little is known about the slope or stiffness factor of stockings. OBJECTIVE: To evaluate the effect of different slope and stiffness factors of medical elastic compression stockings on the venous system. METHODS: Examinations were carried out in 29 legs of 25 different patients (12 men, 13 women) with a mean age of 66.0 years. All patients were known with chronic venous insufficiency. On all these patients three different elastic medical compression stockings were tested; one with a low slope, one with a high slope, and one with a low slope but a higher pressure at the ankle. The tests were carried out by determining capillary filtration rate (CFR) with air-plethysmography (APG) while wearing the stockings. RESULTS: The mean value of the CFR without wearing a stocking was 4.65 ml/min (SD = 1.68), with Compriform (low slope, 30 mmHg) the mean CFR was 3.54 ml/min (SD = 1.22), with Bellavar (high slope, 30 mmHg) a mean CFR of 3.15 ml/min (SD = 1.17) was found, and the mean CFR related to Fast-fit (low slope, 34.5 mmHg) was 3.02 ml/min (SD = 1.12). There is a highly statistically significant difference in CFR between no stockings and wearing a stocking (paired Student's t-test; P < 0.01). Regarding the individual stocking, there is a highly statistically significant difference in CFR between the Compriform and the other two stockings (paired Student's t-test; P < 0.01). Between Bellavar and the Fast-fit the difference was not statistically significant. CONCLUSIONS: There is a statistically significant difference in CFR, and consequently in the development of edema, between not wearing an elastic compression stocking and wearing an elastic compression stocking. There is also a statistically significant difference in CFR between elastic compression stockings with the same compression, but a low slope profile and a high slope profile. Stockings with a low slope, but a higher compression may perform as well as stockings with a higher slope but a lower compression in reducing the CFR. In patients with a strong tendency to develop edema it may be advisable to prescribe stockings with a high slope profile.

Adult↗
PubMed1999

Bockenheimer's syndrome.

A case of a very extensive form of the rare Bockenheimer's syndrome (genuine diffuse phlebectasia) in a 45-year-old female patient is presented. The subject presented phlebectasias of the upper right leg, the vulva and the right side of the abdomen. The diagnostic and therapeutic possibilities for cases of patients with Bockenheimer's syndrome are described.

Abdominal Muscles↗
PubMed1998

Muller's ambulatory phlebectomy and compression.

BACKGROUND: Compression therapy will relieve patients of symptoms of venous disease, if not prevent the occurrence of complications, and is used either alone or in combination with other treatment options. OBJECTIVE: To describe the use of compression in the two main therapy modalities: sclerocompression and ambulatory phlebectomy. METHODS: Aim and mechanism of compression therapy are analyzed and clinical implications are discussed. RESULTS: A modification of compression therapy after ambulatory phlebectomy is suggested based on empirical evidence. CONCLUSIONS: The use of broad compression pads after ambulatory phlebectomy reduces hemorrhage and enhances resorption.

Ambulatory Surgical Procedures↗
PubMed1997

Pressure differences of elastic compression stockings at the ankle region.

BACKGROUND: Elastic compression stockings are widely used medical devices for the prevention of edema and treatment of venous diseases. Many beneficial effects have been described in the past. The exact amount of pressure underneath elastic compression stockings at different areas of the leg remains controversial. OBJECTIVE: To examine the pressure at the skin underneath class II elastic compression stockings at different places around the ankle at the B level. METHODS: Patients with known venous insufficiency and regularly using class II elastic therapeutic compression stockings (25-35 mm Hg) for venous diseases were included. All subjects were wearing completely new stockings at the time of the study. Measurements were performed with an electropneumatic interface pressure measuring device (Oxford Pressure Monitor MK II) with inflatable small sensoring cells. Six sensors were placed around the smallest circumference at the ankle (B-area). The highest and lowest recordings as well as the means were evaluated. RESULTS: The mean pressure of class II elastic stockings measured around the ankle was 24.7 mm Hg (SD, 8.4). The lowest pressures were found at the medial site (18.3 mm Hg; 74% of the mean), and the highest at the pretibial zone (33.9 mm Hg, 137%). CONCLUSIONS: The pressure exerted by pressure class II elastic compression stockings a the medial site just above the ankle (B area) is too low to have influence and improve the venous insufficiency. For phlebology this is the target area. It might be a reason for the high recurrence rate of venous ulcers even if patients wear stockings. Also, the mean pressure of class II stockings was found to be below the normal levels of its pressure class (25-35 mm Hg according to the European CEN classification). The results advocate the use of pressure class III elastic compression stocking more often and the use of pelottes or foam pads.

Ankle↗
PubMed1997

Leg ulcers in Klinefelter's syndrome--further evidence for an involvement of plasminogen activator inhibitor-1.

An abnormality in platelet aggregability or fibrinolysis, namely elevated activity of plasminogen activator inhibitor-1 (PAI-1), has been recently documented in patients suffering from Klinefelter's syndrome associated with leg ulceration without underlying venous insufficiency. To determine whether increased PAI-1 activity is a general feature of Klinefelter's syndrome, or more specifically associated with leg ulceration, we investigated PAI-1 influencing parameters and PAI-1 activity in two groups of patients: (i) Klinefelter patients suffering from leg ulceration (n = 7); and (ii) Klinefelter patients without leg ulceration (n = 6). On analysing PAI-1 influencing parameters such as age, body mass index, triglycerides, C-reactive protein, testosterone, smoking behaviour, the presence of diabetes mellitus, and arterial hypertension, respectively, we found no statistically significant differences between the two groups. However, PAI-1 activity in group 1 was highly significantly elevated compared with that in group two patients (P < 0.005). We conclude that (i) PAI-1 activity is not elevated in Klinefelter's syndrome in general; (ii) elevation of PAI-1 activity in patients suffering from Klinefelter's syndrome does not appear to be secondary to PAI-1 influencing parameters; and (iii) elevation of PAI-1 activity may play a crucial role in the pathogenesis of leg ulceration in Klinefelter's syndrome. Therefore, a therapy for leg ulceration in Klinefelter's syndrome that aims to return the elevated PAI-1 activity to normal should be explored.

Arterial Occlusive Diseases↗
PubMed1997

Elastic compression stockings: durability of pressure in daily practice.

BACKGROUND: Elastic compression stockings are valuable tools in the treatment of many phlebological diseases. As to day no data are available about how long these elastic compression stockings continue to exert enough compression for a proper clinical function. PATIENTS AND METHODS: In this study we measured the pressure at the B level of compression class II and III elastic stockings directly after the patients started to use them, after 1 month, and after 3 months. In total 99 below knee stocking were measured with a TNO-tester, which has officially been accepted by the CEN for measurement of elastic compression stockings. RESULTS: Class II flat knitted stockings showed a mean pressure of 29.3 (SD 4.9) mmHg at the start of the study, declining to 27.6 (SD 5.2) mmHg, and 26.5 (SD 4.4) mmHg, at 1 and 3 months respectively. The round knitted class II had comparable results. In class III flat knitted stockings we measured 47.5 mmHg (SD 8.1) at the start, and 44.2 (SD 7.1) mmHg, and 41.3 (SD 6.7) mmHg, at 1 and 3 months respectively. Extrapolation of the results after 1 and 3 months demonstrate that the mean pressure of class II stocking is less than 25 mmHg after 4 to 5 months. Class III stockings were less than 35 mmHg close to 6 months, if evaluated in the same way. Individual regression analysis show that after 6 months 66% of the pressure class II stockings have a pressure of less than 25 mmHg and 45% of the pressure class III less than 35 mmHg. When considering a 10% safety margin the figures are respectively 84% and 63%. CONCLUSIONS: From the results of this study it can be concluded that, especially for the most frequently used compression class II stockings, three new stockings each year are necessary to ensure an effective function of the stocking during the time they are being used by the patient. For compression class III flat knitted stockings two pairs can be considered as sufficient.

Aged↗
PubMed1996

Effects of medical elastic compression stockings on interface pressure and edema prevention.

BACKGROUND: Although medical elastic compression stockings are widely used in venous diseases their effects on the venous system are still largely unclear. OBJECTIVE: To evaluate the pressure of these medical elastic compression stockings on the skin and their edema protective effects. METHODS: On 18 legs the interface pressure of the stocking on the skin was measured with the aid of an interface pressure measuring instrument (Oxford Pressure Monitor). Five different kinds of medical elastic compression stockings were used. On 11 legs the edema protective effects of the different stockings was evaluated with the use of air-plethysmography. RESULTS: All medical elastic compression stockings used in this study, especially the flat-knitted, showed a good pressure gradient from the B1 level upwards. High pressures were measured at the dorsal foot and the pre-tibial zone. During cuff inflation a special edema protective effect was found in the round-knitted class II stockings. CONCLUSIONS: All class II and III medical elastic compression stockings used in this study have a sufficient pressure (especially class III) and pressure gradient for the treatment of patients with chronic venous insufficiency. Especially round-knitted stockings revealed high pressures on the danger areas such as the dorsal foot. All class II and III stockings provided an effective edema preventive effect; the round-knitted stockings have the best performance, due to their rubber components.

Aged↗
PubMed1996

Transcutaneous oxygen tension in patients with and without pericapillary fibrin cuffs in chronic venous insufficiency, porphyria cutanea tarda and non-venous leg ulcers.

To evaluate the influence of fibrin cuffs on the transcutaneous oxygen tension in patients with chronic venous insufficiency (CVI) we performed a prospective comparative study in an out-patient dermatological department of a district hospital in the Netherlands. 16 patients with CVI grade II or III, 6 patients with porphyria cutanea tarda (PCT) without any sign of CVI, 4 patients with clinical ecthyma type ulcers without CVI and 10 healthy volunteers were studied. Skin biopsies for fibrinogen staining, transcutaneous oxygen tension measurements (TcPO2) and light reflexion rheography (LRR) were performed. TcPO2 readings were significantly lower in patients with CVI compared to patients of the other groups. Fibrin cuffs were found in 8 out of 16 patients with CVI, all PCT patients and 3 out of 4 ecthyma-ulcer patients. On the basis of these results we conclude that the fibrin cuff alone does not act as a barrier for oxygen transport. Fibrin cuffs in CVI are not the cause of venous ulceration but only a part of the complicated mechanism of the altered microcirculation induced by reflux in the venous macrocirculation. Fibrin cuffs are not unique for CVI but an indication of a disturbed microcirculation.

Adult↗
PubMed1996

Leucocytoclastic vasculitis induced by prolonged exercise.

Many people develop skin symptoms after long-distance walks, but little is known about the aetiology of these. In this study we took 11 biopsies from 10 long-distance walkers who walked 80 km. All biopsies originated from purpuric lesions on the lower legs, which had appeared during walking. In all 11 specimens, signs of a leucocytoclastic vasculitis were present with leucocytoclasis, exocytosis of erythrocytes and a granulocyte/mononuclear perivascular infiltrate. Immunofluorescence investigations showed deposition of C3c in many specimens and immunoglobulin M in some. The occurrence of a leucocytoclastic vasculitis after prolonged exercise may be explained by the existence of an exercise altered cutaneous microcirculation, complement activation and an altered immune function.

Complement C3c↗
PubMed1994

[Leg ulcers with hyperpigmented maculae and white atrophy as manifestation of Klinefelter syndrome].

Two patients, men of 38 and 32 years old, had Klinefelter's syndrome in combination with recurrent lower leg ulcers and hyperpigmentations. For the ulcers no venous insufficiency or other underlying cause could be found. Klinefelter's syndrome is characterised by the existence of at least one extra X-chromosome in phenotypical men. Clinical findings are eunochoid body proportions, scanty facial and body hair, gynaecomastia and small testicles. Plasma follicle-stimulating hormone is usually high and testosterone is reduced in about 50% of the patients. Leg ulcers, especially in combination with hyperpigmentation or atrophie blanche of the surrounding skin, can be a symptom of Klinefelter's syndrome and are not necessarily to be attributed to venous insufficiency.

Adult↗
PubMed1994

Increased plasma activity of plasminogen activator inhibitor 1 (PAI-1) in two patients with Klinefelter's syndrome complicated by leg ulcers.

Klinefelter's syndrome is the most frequent major abnormality of sexual differentiation in men with two or more X-chromosomes, and affects one in 500 males. The syndrome is characterized by eunuchoid body proportions, scanty facial and body hair, gynaecomastia, and small firm testes. Leg ulcers, especially in combination with hyperpigmentation, have been reported in association with Klinefelter's syndrome. Thromboembolic processes are also frequently observed. The leg ulcers in patients with Klinefelter's syndrome are usually attributed to venous insufficiency. We describe two patients with Klinefelter's syndrome associated with recurrent ulcers and hyperpigmentation on both legs, in whom no venous or other underlying cause could be found. The patients were not taking any drugs, in particular no supplemental androgen therapy. Both had normal plasma testosterone values. We detected increased activity of plasminogen activator inhibitor 1 (PAI-1), with only a partial decrease upon venous occlusion. A possible role for this inhibitor of fibrinolysis in the pathogenesis of ulceration is discussed.

Adult↗
PubMed1994

Digital photoplethysmography and light reflection rheography. A clinical comparison.

BACKGROUND: Light reflection rheography (LRR) is appropriate for the global assessment of calf-pump insufficiency regardless of whether it is caused by varicosity, the post-phlebitic syndrome, or deep venous thrombosis. The instrument has been increasingly used by many phlebologists. Digital photoplethysmography (D-PPG) is a further development of this well-established LRR. With this D-PPG instrument it is possible, in contrast to LRR, to calibrate the reflected light. OBJECTIVE AND METHODS: To compare the venous refilling times of both the LRR and the D-PPG when measured at the same time on the same leg. We also evaluated the practical use of both instruments. In total we performed 152 simultaneous measurements with both instruments. RESULTS: We found a statistically significant correlation when we compared the venous refilling time of both LRR and D-PPG (r = .664; P < .001). The observed agreement between both instruments for detecting a disturbed venous refilling time (< or = 25 seconds) is 92%. CONCLUSION: Both instruments seems to correlate as has been shown in this and other studies. The D-PPG has the advantage of being more handy. Furthermore the reflected light is calibrated, which enables to compare intra- and interindividual measurements.

Humans↗
PubMed1994

Morphological and functional skin changes in postthrombotic syndrome.

After a period of deep venous thrombosis a lot of patients will develop chronic venous insufficiency. In time different skin alteration will occur. Several hypothesis have been proposed to explain the pathogenesis behind these skin changes. In this paper we will briefly discuss the most important theories. We concentrate on microcirculation and the different skin changes.

Atrophy↗