Exercise with compression stockings improves reflux in patients with mild chronic venous insufficiency

Purpose: This study evaluates the effectiveness of calf muscle strengthening with compression stockings on the haemodynamics in patients with venous disease.

Method: Patients were assigned to a protocol of aggressive management of their chronic venous insufficiency (CVI) including compression stockings (Jobst knee high, 30–40 mmHg ankle), intermittent leg elevation, and a supervised calf muscle strengthening programme. Patients underwent baseline air plethysmography (APG) with and without stockings (T1) and SF-12, Aberdeen varicose vein questionnaire and venous severity score. Exercise sessions included a total of 18, 1 h supervised sessions, 2–3 times per week, consisting of 15 min on treadmill, 10 min on a Stairmaster, 10 min on a Nustep, and 5 min on an airdyne bicycle and lower body strength training. The sessions were supervised by an exercise physiologist. At completion, patients underwent a second APG (T2) and a third (T3) one month later, as well as answering questionnaires. A final venous severity score was assigned.

Results: Eleven patients (7M, 4F), 22 limbs, 14 with CVI and eight without CVI, mean age 60, made up this study. Only two patients suffered from postphlebitic syndrome. In all, 10/11 subjects completed the entire protocol. Although no significant differences were noted in any of the APG parameters between T1 and T2 or T2 and T3, there were significant differences when segregating into C2 ( n = 6 patients with eight involved limbs) and C4, 5 ( n = 5 patients with six involved limbs). Concerning the affected extremities, statistically significant decreases in venous volume (VV) with stockings on between T1 and T2, which reverted back to baseline at T3, and in venous filling index (VFI) between T2 and T3 without stockings were noted ( P<0.05) in C2 limbs. Similar findings were not observed in the C4, C5 limbs, with actual increases in these parameters. Greater increases in ejection fraction were noted in C2 limbs than in C4, C5 limbs. Despite the decrease in reflux in C2 limbs, residual volume fraction (RVF) increased in C2 limbs at T2 both with ( P<0.05) and without stockings, while it decreased in C4, C5 limbs with stockings in place. Finally, outflow fraction (OF) increased only in C2 limbs without stockings in place. Regarding the other parameters, all patients noted improvement in swelling by Aberdeen questionnaire, physical health was improved by SF-12 and patients lost a mean of 3.8 lb of weight.

Conclusions: An exercise programme along with compression stockings resulted in a decrease in reflux, especially during the supervised exercise programme, in patients with mild (C2) chronic venous disease. For more extensive disease (C4, C5), the programme tended to decrease RVF.

Growth rate of infrarenal aortic aneurysms

OBJECTIVE

To delineate the natural history of infrarenal aortic aneurysms with respect to growth rate.

METHODS

A referral based series of 233 patients with abdominal aortic aneurysm was serially assessed by abdominal ultrasound.

RESULTS

The mean age was 71 years and the median follow up 26 months (range 6-146). The mean growth rate of the series was 3.2mm/year. Division of the initial size into those less than 41 mm (128 patients), between 41-60 mm (92 patients) and those above 60 mm (13 patients) in AP diameter showed mean growth rates per year were 2.6 mm/year, 4.1 mm/year and 6.5 mm/year. Examination of the relationship between aneurysm size and subsequent growth rate over the whole study period revealed a rank correlation of 0.19 (p = 0.002). Aneurysms were also observed to expand at an erratic rate both in terms of time and size.

CONCLUSIONS

When the initial decision is to observe the patient, serial ultrasound examinations facilitate later judgements on the balance of risks in relation to surgical treatment.

Structures of four methyltetrazole-containing antiviral compounds in human rhinovirus serotype 14

Four novel antiviral WIN compounds, that contain a methyl tetrazole ring as well as isoxazole, pyridazine or acetylfuran rings, have had their structures determined in human rhinovirus serotype 14 at 2.9 A resolution. These compounds bind in the VP1 hydrophobic pocket, but are shifted significantly towards the pocket pore when compared to previously examined WIN compounds. A putative water network at the pocket pore is positioned to hydrogen bond with these four WIN compounds, and this network can account for potency differences seen in structurally similar WIN compounds.

Picornavirus inhibitors: trifluoromethyl substitution provides a global protective effect against hepatic metabolism

Several modifications of the oxazoline ring of WIN 54954, a broad spectrum antipicornavirus compound, have been prepared in order to address the acid lability and metabolic instability of this compound. We have previously shown that the oxadiazole analogue 3 displayed comparable activity against a variety of rhinoviruses and appeared to be stable to acid. A monkey liver microsomal assay was developed to examine the metabolic stability in vitro of both compounds, and it was determined that WIN 54954 displayed 18 metabolic products while 3 was converted to 8 products. Two major products of 3 were determined by LC-MS/MS to be monohydroxylated at each of the terminal methyl groups. Replacement of the methyl on the isoxazole ring with a trifluoromethyl group, while preventing hydroxylation at this position, did not reduce the sensitivity of the molecule to microsomal metabolism at other sites. However, the (trifluoromethyl)oxadiazole 9 not only prevented hydroxylation at this position but also provided protection at the isoxazole end of the molecule, resulting in only two minor products to the extent of 4%. The major product was identified as the monohydroxylated compound 23. The global metabolic protective effect of trifluoromethyl group on the oxadiazole ring was further demonstrated by examining a variety of analogues including heterocyclic replacements of the isoxazole ring. In each case, the trifluoromethyl analogue displayed a protective effect when compared to the corresponding methyl analogue.