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Pong Kanchanasuttiruk - One of the best experts on this subject based on the ideXlab platform.
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total superficial vein reflux eradication in the treatment of Venous Ulcer
World Journal of Surgery, 2015Co-Authors: Burapa Kanchanabat, Waigoon Stapanavatr, Pong KanchanasuttirukAbstract:Total superficial vein reflux eradication in the treatment of Venous Ulcer. Our initial experience with groin–knee vein stripping resulted in recurrent or unhealed Venous Ulcers prompting us to remove the entire reflux segment with emphasis on the calf superficial vein adjacent to, or underneath the Ulcer. This study aims to assess the healing and recurrent rates after treatment with this technique combined with compression therapy. Pertinent data of the patients with healed or active Venous Ulcers (C5-6) between October 2006 and October 2013 was prospectively collected and retrospectively reviewed. Forty-three operations were performed on 39 C5-6 legs (four reoperations for recurrent Ulcer of the same legs) among 35 patients who had completed follow-up. The median follow-up time was 22 months. Of the 39 operations for active Venous Ulcers (C6), wound healing was achieved in 35 instances (90 %) with a median healing time of 21 days. The 30-day healing rate was 64 % and the 14-day healing rate was 38 %. Only four legs had Ulcers which healed beyond 60 days. The post-operative VCSS and VDS were significantly improved compared with the pre-operative value (11.6, 3.7, p < 0.0001 and 1.0, 0.7, p = 0.035 for VCSS and VDS, respectively). Recurrent Ulceration was found in four legs. The 2- and 6-year recurrence rates were three percent and 22 percent, respectively. Venous Ulcer could be satisfactory treated by the total removal of the peri-Ulcer reflux.
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Total Superficial Vein Reflux Eradication in the Treatment of Venous Ulcer
World journal of surgery, 2015Co-Authors: Burapa Kanchanabat, Waigoon Stapanavatr, Pong KanchanasuttirukAbstract:Total superficial vein reflux eradication in the treatment of Venous Ulcer. Our initial experience with groin–knee vein stripping resulted in recurrent or unhealed Venous Ulcers prompting us to remove the entire reflux segment with emphasis on the calf superficial vein adjacent to, or underneath the Ulcer. This study aims to assess the healing and recurrent rates after treatment with this technique combined with compression therapy. Pertinent data of the patients with healed or active Venous Ulcers (C5-6) between October 2006 and October 2013 was prospectively collected and retrospectively reviewed. Forty-three operations were performed on 39 C5-6 legs (four reoperations for recurrent Ulcer of the same legs) among 35 patients who had completed follow-up. The median follow-up time was 22 months. Of the 39 operations for active Venous Ulcers (C6), wound healing was achieved in 35 instances (90 %) with a median healing time of 21 days. The 30-day healing rate was 64 % and the 14-day healing rate was 38 %. Only four legs had Ulcers which healed beyond 60 days. The post-operative VCSS and VDS were significantly improved compared with the pre-operative value (11.6, 3.7, p
Burapa Kanchanabat - One of the best experts on this subject based on the ideXlab platform.
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total superficial vein reflux eradication in the treatment of Venous Ulcer
World Journal of Surgery, 2015Co-Authors: Burapa Kanchanabat, Waigoon Stapanavatr, Pong KanchanasuttirukAbstract:Total superficial vein reflux eradication in the treatment of Venous Ulcer. Our initial experience with groin–knee vein stripping resulted in recurrent or unhealed Venous Ulcers prompting us to remove the entire reflux segment with emphasis on the calf superficial vein adjacent to, or underneath the Ulcer. This study aims to assess the healing and recurrent rates after treatment with this technique combined with compression therapy. Pertinent data of the patients with healed or active Venous Ulcers (C5-6) between October 2006 and October 2013 was prospectively collected and retrospectively reviewed. Forty-three operations were performed on 39 C5-6 legs (four reoperations for recurrent Ulcer of the same legs) among 35 patients who had completed follow-up. The median follow-up time was 22 months. Of the 39 operations for active Venous Ulcers (C6), wound healing was achieved in 35 instances (90 %) with a median healing time of 21 days. The 30-day healing rate was 64 % and the 14-day healing rate was 38 %. Only four legs had Ulcers which healed beyond 60 days. The post-operative VCSS and VDS were significantly improved compared with the pre-operative value (11.6, 3.7, p < 0.0001 and 1.0, 0.7, p = 0.035 for VCSS and VDS, respectively). Recurrent Ulceration was found in four legs. The 2- and 6-year recurrence rates were three percent and 22 percent, respectively. Venous Ulcer could be satisfactory treated by the total removal of the peri-Ulcer reflux.
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Total Superficial Vein Reflux Eradication in the Treatment of Venous Ulcer
World journal of surgery, 2015Co-Authors: Burapa Kanchanabat, Waigoon Stapanavatr, Pong KanchanasuttirukAbstract:Total superficial vein reflux eradication in the treatment of Venous Ulcer. Our initial experience with groin–knee vein stripping resulted in recurrent or unhealed Venous Ulcers prompting us to remove the entire reflux segment with emphasis on the calf superficial vein adjacent to, or underneath the Ulcer. This study aims to assess the healing and recurrent rates after treatment with this technique combined with compression therapy. Pertinent data of the patients with healed or active Venous Ulcers (C5-6) between October 2006 and October 2013 was prospectively collected and retrospectively reviewed. Forty-three operations were performed on 39 C5-6 legs (four reoperations for recurrent Ulcer of the same legs) among 35 patients who had completed follow-up. The median follow-up time was 22 months. Of the 39 operations for active Venous Ulcers (C6), wound healing was achieved in 35 instances (90 %) with a median healing time of 21 days. The 30-day healing rate was 64 % and the 14-day healing rate was 38 %. Only four legs had Ulcers which healed beyond 60 days. The post-operative VCSS and VDS were significantly improved compared with the pre-operative value (11.6, 3.7, p
Waigoon Stapanavatr - One of the best experts on this subject based on the ideXlab platform.
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total superficial vein reflux eradication in the treatment of Venous Ulcer
World Journal of Surgery, 2015Co-Authors: Burapa Kanchanabat, Waigoon Stapanavatr, Pong KanchanasuttirukAbstract:Total superficial vein reflux eradication in the treatment of Venous Ulcer. Our initial experience with groin–knee vein stripping resulted in recurrent or unhealed Venous Ulcers prompting us to remove the entire reflux segment with emphasis on the calf superficial vein adjacent to, or underneath the Ulcer. This study aims to assess the healing and recurrent rates after treatment with this technique combined with compression therapy. Pertinent data of the patients with healed or active Venous Ulcers (C5-6) between October 2006 and October 2013 was prospectively collected and retrospectively reviewed. Forty-three operations were performed on 39 C5-6 legs (four reoperations for recurrent Ulcer of the same legs) among 35 patients who had completed follow-up. The median follow-up time was 22 months. Of the 39 operations for active Venous Ulcers (C6), wound healing was achieved in 35 instances (90 %) with a median healing time of 21 days. The 30-day healing rate was 64 % and the 14-day healing rate was 38 %. Only four legs had Ulcers which healed beyond 60 days. The post-operative VCSS and VDS were significantly improved compared with the pre-operative value (11.6, 3.7, p < 0.0001 and 1.0, 0.7, p = 0.035 for VCSS and VDS, respectively). Recurrent Ulceration was found in four legs. The 2- and 6-year recurrence rates were three percent and 22 percent, respectively. Venous Ulcer could be satisfactory treated by the total removal of the peri-Ulcer reflux.
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Total Superficial Vein Reflux Eradication in the Treatment of Venous Ulcer
World journal of surgery, 2015Co-Authors: Burapa Kanchanabat, Waigoon Stapanavatr, Pong KanchanasuttirukAbstract:Total superficial vein reflux eradication in the treatment of Venous Ulcer. Our initial experience with groin–knee vein stripping resulted in recurrent or unhealed Venous Ulcers prompting us to remove the entire reflux segment with emphasis on the calf superficial vein adjacent to, or underneath the Ulcer. This study aims to assess the healing and recurrent rates after treatment with this technique combined with compression therapy. Pertinent data of the patients with healed or active Venous Ulcers (C5-6) between October 2006 and October 2013 was prospectively collected and retrospectively reviewed. Forty-three operations were performed on 39 C5-6 legs (four reoperations for recurrent Ulcer of the same legs) among 35 patients who had completed follow-up. The median follow-up time was 22 months. Of the 39 operations for active Venous Ulcers (C6), wound healing was achieved in 35 instances (90 %) with a median healing time of 21 days. The 30-day healing rate was 64 % and the 14-day healing rate was 38 %. Only four legs had Ulcers which healed beyond 60 days. The post-operative VCSS and VDS were significantly improved compared with the pre-operative value (11.6, 3.7, p
Joseph D. Raffetto - One of the best experts on this subject based on the ideXlab platform.
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omics profiles in chronic Venous Ulcer wound fluid innovative applications for translational medicine
Expert Review of Molecular Diagnostics, 2014Co-Authors: Ferdinando Mannello, Daniela Ligi, Matteo Canale, Joseph D. RaffettoAbstract:Chronic Venous disease represents a healthcare problem due to high prevalence and recurrence rates. Studies on chronic Venous Ulcer wound fluid (CVUWF) have demonstrated increased inflammation and proteolysis which can cause tissue destruction and delayed healing. This review discusses: nearly all known metabolites discovered in the past 25 years in CVUWF studies; the omics approaches characterizing the microenvironment of human Venous leg Ulcers; and the use of biocompounds as prognostic biomarkers and as possible targets for therapeutic approaches. A biomarker is a biological compound that can be functional or non-functional, specific or non-specific in the diagnosis/prognosis to a disease state and may be quantified to determine progression or regression of disease. Omics studies in CVUWF provide the impetus for future identification of biomarkers within the intricate network in chronic Venous disease and set the basis for determining the appropriate combination of molecules that are expressed with the healing status of Venous leg Ulcers.
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Venous Ulcer: what is new?
Plastic and Reconstructive Surgery, 2011Co-Authors: Joseph D. Raffetto, William A. MarstonAbstract:The pathophysiology of Venous dermal abnormality in chronic Venous Ulcers is reflective of a complex interplay that involves sustained Venous hypertension, inflammation, changes in the microcirculation, cytokine and matrix metalloproteinase activation, and altered cellular function. Red blood cells and macromolecules extravasate into the interstitium and activate endothelial cells. Endothelial expression of specific adhesion molecules recruits leukocytes and causes diapedesis of these cells into the dermal microvasculature, promoting an inflammatory response with activation of cytokines and proteinases. Altered cell function enhances a state of vulnerability in the surrounding tissues, initiating specific changes associated with Venous disease. Ultimately, the persistent inflammatory-proteinase activity leads to advanced chronic Venous insufficiency and Ulcer formation. The mainstay of therapy in Venous Ulcer abnormality is correction of the underlying Venous hypertension through compression therapy and/or surgery. Understanding the science involved in the pathophysiology of Venous Ulcer formation has led to the development of adjunctive treatment directed at the dysregulated molecular pathways. Randomized clinical trials are critical for determining the most effective evidence-based treatments for Venous Ulcer, and this review discusses important trials that have had a significant impact on Venous Ulcer healing. In addition, the authors have included subsections referred to as "Translational Implications for Therapy" in the basic science sections of the review to help bridge the basic science knowledge with clinical applications that may help to modulate the molecular abnormalities in the pathophysiologic cascade leading to Venous Ulcers.
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Venous Ulcer fibroblasts respond to basic fibroblast growth factor at the cell cycle protein level
Annals of Vascular Surgery, 2006Co-Authors: Craig S Seidman, Joseph D. Raffetto, Kristen C Overman, James O MenzoianAbstract:Fibroblasts cultured from Venous Ulcers demonstrate phenotypic characteristics of cellular senescence including slow growth, altered morphology, upregulation of fibronectin, and increased senescence-associated β-galactosidase activity. In senescent cells, arrest of cell replication is related to overexpression of p21 and underexpression of phosphorylated tumor-suppressor protein retinoblastoma (ppRb). The regulatory mechanisms for cell proliferation in Venous Ulcer fibroblasts are unknown. In this study, Venous Ulcer fibroblasts are examined for cell cycle protein expression and modulation by basic fibroblast growth factor (bFGF). Fibroblasts were isolated from the Venous Ulcer of the distal lower extremity (fb-D) of patients with chronic Venous insufficiency. A control biopsy was obtained from the proximal ipsilateral thigh (fb-P). Paired cultures were plated at 100,000 cells/plate and the cells synchronized. After 24 hr, one culture set was treated with bFGF (20 ng/mL) and the other was kept in culture medium only (untreated). All cultures, treated and untreated, were lysed following 24 hr of incubation, and the lysate was used to perform immunoblot analysis for p21, ppRb, and cyclin D1. Immunoblot samples were standardized to protein content. In all patients analyzed (n = 4), at basal levels (untreated) fb-D demonstrated significant overexpression of p21 versus fb-P (p = 0.016). Treatment with bFGF resulted in significant downregulation of p21 levels for fb-D (p = 0.008) and fb-P (p = 0.037) compared to untreated fibroblasts. ppRb was underexpressed in fb-D versus fb-P (p = 0.069). Treatment with bFGF increased ppRb significantly in fb-D (p = 0.030) and in fb-P (p = 0.027) compared to untreated fibroblasts. No differences were observed in cyclin D1 with respect to basal levels in fb-P versus fb-D or in treated versus untreated groups. Venous Ulcer fibroblasts show phenotypic similarity to senescent cells, with overexpression of p21 as well as down regulation of phosphorylated pRb. The aberrations seen in the cell cycle proteins in fb-D are similar to those seen in senescent cells; however, bFGF can modulate important cell cycle regulatory proteins, promoting a proliferative environment in fb-D that is not possible in a senescent cell. The role of bFGF may be useful in the clinical treatment of Venous Ulcer pathology.
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the proliferative capacity of neonatal skin fibroblasts is reduced after exposure to Venous Ulcer wound fluid a potential mechanism for senescence in Venous Ulcers
Journal of Vascular Surgery, 1999Co-Authors: Manuel V Mendez, Joseph D. Raffetto, Tania J. Phillips, James O Menzoian, Heeyoung ParkAbstract:Abstract Purpose: We have previously shown that fibroblasts cultured from Venous Ulcers display characteristics of senescence and have reduced growth rates. Susceptibility of young fibroblasts to the microcirculatory changes associated with Venous Ulcers, such as macrophage trapping and activation, could explain the prevalence of senescent fibroblasts in these wounds. Methods: We tested the in vitro effect of Venous Ulcer wound fluid (VUWF), as well as pro-inflammatory cytokines known to be present in VUWF (TNF-α, IL-1β, and TGF-β1), on neonatal foreskin fibroblasts (NFFs). NFF growth rates, cellular morphology, and senescence-associated β-galactosidase (SA-β-Gal) activity were determined in the presence or absence of VUWF and the above cytokines. VUWF TNF-α concentration and the effect of anti–TNF-α antibody on VUWF inhibitory activity were determined in samples obtained from four patients with Venous Ulcers. Results: NFF growth rates were significantly reduced by VUWF (42,727 ± 6301 vs 3902 ± 2191 P = .006). TNF-α also significantly reduced NFF growth rates in a dose-dependent manner ( P = .01). No significant growth-inhibitory activity was seen for IL-1α or TGF-β. Incubation with VUWF significantly increased the percentage of SA-β-Gal–positive fibroblasts in vitro on culture day 12 ( P = .02). TNF-α and TGF-β1 had similar effects. TNF-α was detected in all VUWF tested, with a mean of 254 ± 19 pg/mL. Conclusion: These data suggest that the Venous Ulcer microenvironment adversely affects young, rapidly proliferating fibroblasts such as NFFs and induces fibroblast senescence. Pro-inflammatory cytokines such as TNF-α and TGF-β1 might be involved in this process. The role of other unknown inhibitory mediators, as well as pro-inflammatory cytokines, in Venous Ulcer development and impaired healing must be considered. (J Vasc Surg 1999;30:734-43.)
C V Ruckley - One of the best experts on this subject based on the ideXlab platform.
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popliteal vein reflux reduces the healing of chronic Venous Ulcer
British Journal of Surgery, 1998Co-Authors: Julie Brittenden, A W Bradbury, P L Allan, R J Prescott, D R Harper, C V RuckleyAbstract:Background The relationship between deep and superficial Venous reflux and healing of Venous Ulceration by non-operative compression therapy has not been studied previously. Methods A total of 155 patients with chronic Venous Ulcers underwent duplex ultrasonography before treatment with compression bandaging at a hospital-based Venous clinic. Results At 24 weeks, 104 (67 per cent) of Ulcers had healed. There was no significant difference in the pattern of either deep or superficial Venous reflux between healed and non-healed Ulcers except with respect to the popliteal vein. In healed Ulcers, 39 scans (38 per cent) indicated competence of the above-knee popliteal vein compared with five (10 per cent) in the non-healing group (P < 0·001, χ2 test). Similarly, 43 scans (42 per cent) showed below-knee popliteal vein competence in the healed Ulcers compared with only five (10 per cent) performed in legs remaining Ulcerated (P < 0·001, χ2 test). Conclusion Popliteal vein incompetence is an indicator of poor response to compression therapy for Venous Ulceration. © 1998 British Journal of Surgery Society Ltd