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Objective: To investigate the effectiveness of transvenous occlusion of incompetent pelvic veins in women presenting with chronic pelvic pain (CPP) in improving symptoms and quality of life. Design: Patient‐blinded randomised controlled trial with objective outcome measures. Results were analysed on an intention‐to‐treat basis. Setting: Gynaecology and Vascular Surgery Services of two teaching hospitals in northwest England. Population: Sixty women aged 18–54 years presenting with CPP after exclusion of other pathology, and who were found to have pelvic vein incompetence. Methods: Participants were randomised and assigned to contrast venography alone or contrast venography plus transvenous occlusion of the incompetent pelvic veins. Main outcome measure: The primary outcome was change in pain score measured using the short‐form McGill Pain Score (SF‐MPQ) and the Visual Analogue Score (VAS) recorded at 12 months post‐randomisation. Secondary outcomes included quality of life using the EQ‐5D instrument, symptomatic improvement and procedure‐related complications. Results: Sixty participants were randomised to transvenous occlusion of incompetent pelvic veins or venography only. At 12 months, median pain scored 2 (3–10) in the intervention group versus 9 (5–22) in controls (p = 0.016). Pain on the VAS scored 15 (0–3) versus 53 (20–71), respectively (p = 0.002). Median EQ‐5D improved after intervention from 0.79 (0.74–0.84) to 0.84 (0.79–1.00; p = 0.008) over 12 months. No major complications were reported. Conclusion: Transvenous occlusion of pelvic vein incompetence reduced pain scores, improved quality of life and diminished symptom burden with no major reported complications. Trial registration: ISRCTN 15091500. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between chronic pelvic pain (CPP) and pelvic vein incompetence (PVI) or pelvic varices. Design: Case–control study. Setting: Gynaecology and vascular surgery services in two teaching hospitals in north‐west England. Sample: A total of 328 premenopausal women (aged 18–54 years), comprising 164 women with CPP and 164 matched controls with no history of CPP. Methods: Symptom and quality‐of‐life questionnaires and transvaginal duplex ultrasound for PVI and pelvic varices. Main outcome measures: Venous reflux of >0.7 s in the ovarian or internal iliac veins (primary outcome) and presence of pelvic varices (secondary outcome). Statistical analysis compared the prevalence of PVI between women with and without CPP using the two‐sided chi‐square test. Logistic regression was used to compare the odds of having PVI and pelvic varices between women with and without CPP. Results: Pelvic vein incompetence was found on transvaginal duplex ultrasound in 101/162 (62%) women with CPP, compared with 30/164 (19%) asymptomatic controls (OR 6.79, 95% CI 4.11–11.47, p < 0.001). Forty‐three of 164 (27%) women with CPP had pelvic varices compared with three of 164 (2%) asymptomatic women (OR 18.9, 95% CI 5.73–62.7, p < 0.001). Conclusions: There was a significant association between PVI, as detected by transvaginal duplex imaging, and CPP. Pelvic varices were strongly associated with CPP and were infrequently seen in control patients. These results justify further evaluation of PVI and its treatment in well‐designed research. [ABSTRACT FROM AUTHOR]

Venous leg ulcers (VLUs) have a significant impact on approximately 3% of the adult population worldwide, with a mean NHS wound care cost of £7600 per VLU over 12 months. The standard care for VLUs is compression therapy, with a significant number of ulcers failing to heal with this treatment, especially with wound size being a risk factor for non‐healing. This multicentre, prospective, randomised trial evaluated the safety and effectiveness of autologous skin cell suspension (ASCS) combined with compression therapy compared with standard compression alone (Control) for the treatment of VLUs. Incidence of complete wound closure at 14 weeks, donor site closure, pain, Health‐Related Quality of Life (HRQoL), satisfaction, and safety were assessed in 52 patients. At Week 14, VLUs treated with ASCS + compression had a statistically greater decrease in ulcer area compared with the Control (8.94 cm2 versus 1.23 cm2, P =.0143). This finding was largely driven by ulcers >10 to 80 cm2 in size, as these ulcers had a higher mean percentage of reepithelialization at 14 weeks (ASCS + compression: 69.97% and Control: 11.07%, P =.0480). Additionally, subjects treated with ASCS + compression experienced a decrease in pain and an increase in HRQoL compared with the Control. This study indicates that application of ASCS + compression accelerates healing in large venous ulcers. [ABSTRACT FROM AUTHOR]

Objectives Previous studies have identified sub-syndromes of behavioral and psychological symptoms of dementia. But because of their cross-sectional design, the stability of these sub-syndromes over time remains unknown. Method Behavioral and psychological symptoms of dementia of 84 participants (out of an original sample of 144 patients) with Alzheimer's disease and vascular dementia were assessed by using the Neuropsychiatric Inventory every six months for two years. Principal component factor analysis with Varimax rotation was used to detect neuropsychiatric sub-syndromes at each time point. Results The 12 symptoms were reduced to four factors at baseline, 12, 18, and 24 months and three factors at six months. None of the factor structures matched the four sub-syndromes previously identified by studies. The most stable group of symptoms were a combination of 'psychosis' and 'hyperactivity' symptoms (delusions, hallucinations, irritability, agitation), which became stable at 18 months. Conclusions The pattern of behavioral and psychological symptoms of dementia sub-syndromes over time has not been studied before, and this research suggests that some stability is evident particularly during the later stages of the disease process. These findings have implications for patients and their caregiver. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Asymptomatic spontaneous cerebral emboli (SCE) are common in dementia and are associated with cognitive decline in dementia. The significance of their presence in older people is unknown. Method We included 96 participants (mean (SD) age 76.8 (6.7) years, 46% female) who were the control group in a case-control study to evaluate SCE in dementia. Cognitive functioning was assessed prospectively over 2.5 years, using the MMSE and CAMCOG. Results The mean (SD) MMSE score was 28.7 (1.4) at baseline with an average (SD) drop of 0.79 (0.91) per year. The presence of SCE was not related to the annual drop in MMSE score, nor to the CAMCOG score at follow-up (p = 0.88 and p = 0.41, respectively). Linear regression analyses identified higher age in years (β = 0.29, p = 0.003), history of stroke (β = 0.31, p = 0.001) and carotid stenosis (β = 0.28, p = 0.003) as independent predictors of cognitive decline. Conclusion We found no association between the presence of SCE and subsequent cognitive decline in older people without dementia. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the association between the angiotensin-converting enzyme (ACE) deletion/insertion (D/I) polymorphism and white matter hyperintensities (WMHs) in patients with dementia. DESIGN: Observational pilot study with adjustment for potential confounders using analysis of covariance. SETTING: Secondary care old-age psychiatry services in greater Manchester, United Kingdom. PARTICIPANTS: Ninety-seven patients with dementia: 49 with Alzheimer's disease (AD, National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria) and 48 with vascular dementia (VaD, National Institute of Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences criteria). MEASUREMENTS: The ACE D/I polymorphism, WMHs (deep WMHs (DWMHs) and periventricular hyperintensities (PVHs)) on T2-weighted magnetic resonance imaging, and potential cardiovascular confounders. RESULTS: The D/D polymorphism of the ACE genotype was associated with severity of DWMH ( P=.005) but not PVH ( P=.34), corrected for age, cardiovascular risk factors, and type of dementia. Post hoc analyses were limited by statistical power but suggested an interaction with the apolipoprotein E ℇ4 allele. CONCLUSION: The results support previous observations that genetic factors influence the development of WMHs in dementia. The involvement of the ACE D/I polymorphism in the pathogenesis of DWMHs in dementia (AD and VaD), by a mechanism that is independent of its association with cardiovascular risk factors, should be confirmed in a large population-based sample. [ABSTRACT FROM AUTHOR]

BACKGROUND: The risks associated with allogeneic blood transfusion are increasingly recognized. More blood is cross-matched for moderate blood loss surgery than any other indication. The role of acute normovolemic hemodilution (ANH) as a blood transfusion strategy was evaluated in a prospective randomized controlled trial. STUDY DESIGN AND METHODS: A total of 155 patients undergoing elective hip surgery were randomly assigned to either “ANH” (n = 78) or “standard transfusion” (n = 77). ANH on induction of anesthesia was to a target hemoglobin (Hb) level of 110 g per L with return of autologous blood on wound closure. Allogeneic blood was prescribed by an objective transfusion trigger based on an Hb level of less than 80 g per L. Transfusion requirements and postoperative complications were recorded. RESULTS: Allogeneic transfusion was necessary in 22 (29%) standard transfusion patients and 15 (19%) ANH (odds ratio [OR], 0.6; 95% CI, 0.28-1.3; p = 0.23) with 63 and 33 units transfused, respectively (p = 0.1). Significant postoperative complications occurred in 30 (38%) standard transfusion patients compared with 14 (18%) of those randomly assigned to ANH (OR, 0.3; 95% CI, 0.14-0.65; p = 0.009). The major difference between the groups was the frequency of infective complications. CONCLUSION: Despite modest allogeneic transfusion requirements in hip surgery, ANH reduced postoperative complications. [ABSTRACT FROM AUTHOR]

Background The causes of the common dementias remain unknown. Paradoxical embolisation of the cerebral circulation by venous thrombi passing through venous to arterial shunts (v-aCS) in the heart or pulmonary circulation is known to occur in cryptogenic stroke and post-operative confusion following hip replacement. Objectives To explore the role of paradoxical embolisation in dementia by investigating for cerebral emboli, venous to arterial circulation shunt (v-aCS) and carotid artery disease. Methods Forty-one patients with dementia (24 Alzheimer's AD and 17 vascular VaD) diagnosed using DSM-IV criteria and 16 controls underwent transcranial Doppler (TCD) detection of spontaneous cerebral emboli in both middle cerebral arteries. A v-aCS was detected by intravenous injection of an air/saline ultrasound contrast at rest and after provocation by coughing and Valsalva's manoeuvre. Carotid artery disease was assessed by duplex imaging. Results Cerebral emboli were detected in 11 (27.5%) dementia patients compared with one (7%) control (p = 0.15) with emboli being most frequent in VaD (41%) compared to controls [OR (95% CI): 10.5 (1.1, 98.9), p = 0.04]. A v-aCS was detected in 25 (61%) patients and seven (44%) controls (p = 0.24). In dementia patients with cerebral emboli; v-aCS was detected in seven (64%) and moderate to severe carotid stenosis was present in three (30%). Conclusion Cerebral emboli and v-aCS may be more frequent in patients with both VaD and AD than in controls, which suggest paradoxical embolisation as a potential mechanism for cerebral damage. This pilot study justifies a definitive case-control study. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

SUMMARY Cell salvage is an autologous blood transfusion technique, which has been in common use for over twenty years. It has the obvious potential to reduce allogeneic blood usage as fresh red cells that would otherwise be lost are reinfused. Properly used, there is no risk of clerical error and no need to screen for transmissible disease. Although used extensively in the USA and Europe, the adoption of cell salvage, and indeed all autologous blood transfusion techniques, has been very slow in the UK. This may be partly due to the paucity of adequately powered randomized clinical trials demonstrating the efficacy and cost-effectiveness of cell salvage. This article will review these aspects of cell salvage with particular emphasis on its routine use in vascular surgery. [ABSTRACT FROM AUTHOR]

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