Posterolateral thigh perforator varicosities in 12 patients: A normal deep venous system and successful treatment with ultrasound-guided sclerotherapy
DERMATOLOGIC SURGERY
Authors: van Neer, Pierre; Veraart, Joep C. J. M.; Neumann, Hamartino
Abstract
OBJECTIVES To determine whether in patients with posterolateral thigh perforator (PLTP) varicosities ultrasound-guided sclerotherapy (USGS) is successful and to determine any deep venous anomaly. PATIENTS Twelve consecutive patients with PLTP varicosities were investigated and treated. DESIGN In this prospective intervention study USGS of the PLTP with polidocanol microfoam 1-2% was performed with a maximal number of three treatments. Clinical pictures and Duplex imaging were performed before and after treatment. Ascending phlebography was performed in 9 patients. RESULTS Ten patients showed a marked success, defined as no PLTP varicosities visible and no reflux detectable. In 2 patients there was moderate success. The mean number of treatments was 1.58, the mean diameter of the PLTP vein was reduced from 4.06 (range, 2.2-6.1) to 1.97 (range, 0-3.3) mm (p=0.003, Wilcoxon signed rank test). No serious side effects were noted. No deep venous anomaly was found in the phlebographic study. CONCLUSION In patients with PLTP varicosities, USGS is very successful, with very few side effects. No deep venous anomalies were found in our study, which conforms to the literature.
High-density lipoprotein (HDL) transport in the metabolic syndrome: Application of a new model for HDL particle kinetics
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
Authors: Ji, JY; Watts, GF; Johnson, AG; Chan, DC; Ooi, EMM; Rye, KA; Serone, AP; Barrett, PHR
Abstract
Context: Reduced high density lipoprotein (HDL) concentration in the metabolic syndrome (MetS) is associated with increased risk of diabetes and cardiovascular disease and is related to defects in the kinetics of HDL apolipoprotein (apo) A-I and A-II. Objective: The objective of the study was to investigate HDL apoA-I and apoA-II kinetics in nondiabetic men with MetS and lean controls by developing a model that describes the kinetics of lipoprotein (Lp)A-I and LpA-I:A-II particles. Design: Twenty-three MetS men and 10 age-matched lean controls were investigated. ApoA-I and apoA-II tracer/tracee ratios were studied after iv d(3)-leucine administration using gas chromatography mass spectrometry. Results: Compared with lean subjects, MetS subjects had accelerated catabolism of LpA-I (P < 0.001), LpA-I:A-II (P = 0.005), and apoA-II P = 0.005); the production rate of LpA-I was also significantly elevated in MetS, so that the dominant changes in plasma concentrations were reduction in LpA-I:A-II (P < 0.001) and apoA-II (P < 0.05). Increased catabolism of LpA-I and LpA-I:A-II was directly related to increased waist circumference, hypertriglyceridemia, low HDL-cholesterol, small HDL particle size, hyperinsulinemia, and low phospholipid transfer protein (PLTP) activity; overproduction of LpA-I was significantly associated with increased waist circumference, insulin resistance, and low PLTP activity. Conclusions: MetS men exhibit hypercatabolism of the two major HDL lipoprotein particles, LpA-I and LpA-I:A-II, but selective overproduction of LpA-I maintains a normal plasma concentration of LpA-I. These kinetic perturbations are probably related to central obesity, insulin resistance, hypertriglyceridemia, and low plasma PLTP activity.