Treatment of Venous Ulceration by Injection Sclerotherapy and Compression Hosiery: A 5-Year Study

Objective:

To determine whether the use of graduated compression stockings reduces the rate of recurrence of venous ulceration.

Design:

Prospective, closed, non-randomised study of 126 patients with a previous history of venous ulceration for five years.

Setting:

The Varicose Vein Clinic of Sir Patrick Dun's and Adelaide Hospitals.

Patients:

126 patients attending the Varicose Vein Clinic who had undergone successful healing of venous ulcers by injection compression sclerotherapy.

Intervention:

All patients underwent clinical examination and venous pressure measurement, and were then fitted with graduated compression stockings. Those patients dropping out of the study (21) were used as a comparison group.

Main outcome measure:

The recurrence rate of venous ulcers.

Results:

At the end of the 5 year study period patients were divided into 3 groups – those who had ulcer recurrence (33), those who were free of ulcers (72), and those (21) who had dropped out of the study, the last group showing a higher recurrence rate than those who had worn stockings.

A Simple Doppler Technique for the Rapid Diagnosis of Significant Sapheno-Femoral Reflux

The clinical diagnosis or sapheno-femoral incompetence is frequently inaccurate. Using a simple Doppler technique described below 94% of 155 limbs in 107 patients were correctly diagnosed. In the same group of patients the cough impulse test gave an accurate positive result in only 79%, while in the first 100 limbs of the series tourniquet and tap tests were even less reliable. Since the Doppler technique is readily applicable to large numbers of patients it is concluded that it will be of use in distinguishing those in whom surgery is required from others in whom compression sclerotherapy will be effective.

Predictors of first hip fracture and mortality post fracture in older women

BACKGROUND

Hip fracture causes significant morbidity and mortality in older women.

AIM

To document factors contributing to the risk of hip fracture in older women and to assess the effect of hip fracture on subsequent mortality.

METHODS

Case-control study of 89 women with hip fracture and 89 controls, with two-year follow-up. Singh index and bone mineral density were calculated.

RESULTS

Osteoporotic indices did not differ significantly between cases and controls. Significant predictors of risk were sleeping tablets, perception of health as fair/poor and a lower mental status score. Patients were 3.57 times more likely to die in the first year after fracture, with no difference between the groups in year two. After adjustment, hip fracture did not remain significantly associated with mortality. Inability to walk 100 yards alone prior to fracture and lower social class were significantly associated with mortality at 12 months. Age alone was significantly associated at 12-24 months.

CONCLUSIONS

Factors related to falls and fracture may be more discriminatory predictors of hip fracture risk than osteoporosis in older females. Medications for sleep should be prescribed with caution. Hip fracture may have an independent effect on one year mortality, this effect is not seen in the second year.

Evaluation of quantitative CT vertebral bone mineral density measurement and the Singh index in elderly females with hip fractures--a case control study

This study aims to evaluate the ability of quantitative computed tomography (QCT) bone mineral density (BMD) measurement of vertebral bodies to predict risk of hip fracture. We also examine the predictive value of the radiographic Singh index and its relationship to the vertebral BMD. The vertebral BMD (using a QCT protocol) and radiographic Singh index were evaluated in 86 white females who had sustained a hip fracture after minor trauma. 86 age-matched female controls were also studied. All patients were post-menopausal, the age range was 52-95 years. BMD values were found to be low in both the study group and controls; there was no statistically significant difference between the groups. A low Singh index did not correlate with hip fracture, nor did it correlate with low vertebral BMD measurement. We conclude that vertebral BMD and radiographic Singh index are not reliable predictors of hip fracture in the elderly female.