Severity of chronic venous disease and anatomic distribution of valvular incompetence

AIM

The aim of the study was to examine the association between anatomical patterns of valvular incompetence and the severity of venous insufficiency in patients with chronic venous disease.

METHODS

A total of 211 consecutive patients (70% females) were referred from the vascular clinic to undergo a Doppler ultrasound examination. The extent and anatomical pattern of valvular incompetence was noted using CEAP criteria. Clinical classes C1-6 for each patient were expressed as a string of binary digits and translated into a clinical ordinal score. In this way, higher grade signs were not obscuring lower grade signs and non-parametric analysis could include a wider range of clinical data.

RESULTS

Varicose veins were the main complaint in 33% of the patients. 54% had at least one incompetent deep vein, 80% had incompetent perforators. Clinical severity increased with age, but was not related with gender. The presence of deep venous incompetence did not account for significant increase in signs. Superficial incompetence, especially if involving two or more segments, was most commonly seen in patients with severe signs. A linear regression model for clinical ordinal score identified non-saphenous superficial reflux and small saphenous vein reflux as the strongest predictors of clinical severity.

CONCLUSION

CEAP clinical classes can be translated into a clinical ordinal score, which is useful for data analysis. In a group with chronic venous disorders, clinical status is associated mostly with the condition of superficial and calf perforating veins.

Estimation of usefulness of positron emission tomography (PET) in the diagnosis of post-traumatic stress disorders--preliminary report

The aim of this study was to evaluate the possibility of using PET both in assessing the susceptibility to stress and in the diagnosis of post-traumatic stress disorders. Mentally and somatically healthy soldiers were subjected to PET-CT head scan examinations before and after virtual reality stimulation with warfare scenarios. Despite stimulation of peripheral nervous system after 10 minutes, VR exposure in any of the examined soldiers simulation did not cause changes in any brain structure that was visualized in PET. PET-CT head scan was also performed in patients with typical symptoms of acute PTSD according to the criteria of DSM IV TR. In those patients no changes in any brain structure was found. Initially it was found that VR exposure techniques like clinically typical acute symptoms of PTSD do not leave changes in CNS, which could be visualized in PET. The preliminary hypothesis was put forward that exposure to stimuli like symptoms of PTSD must remain long enough to induce permanent damage of brain structure.