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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]

Background Pelvic vein incompetence is a cause for pelvic pain and recurrent varicose veins in women. The gold standard diagnostic method is reflux venography involving radiation, nephrotoxic contrast and jugular puncture. Trans-vaginal ultrasound (TVU) is increasingly being used as a diagnostic tool for pelvic vein incompetence. Methods Fifty women with clinical suspicion of pelvic vein incompetence and aged between 18 and 55 years were recruited prospectively over two years at a large UK University Teaching Hospital. Trans-vaginal ultrasound was performed using a standardised protocol which included assessment of the ovarian and internal iliac veins bilaterally in the supine and semi-standing position with provocative manoeuvres. Diagnostic readability and inter-observer variability was determined. Results Mean (range) age of 43 (23-51). Visibility of all four pelvic veins was better in the supine position compared with semi-standing position (76% vs 64%). Pelvic vein incompetence was identified in 34 of 50 (68%) women in the supine position compared with 38 of 50 (76%) women in the semi-standing position. Pelvic vein incompetence was demonstrated in 35 of 50 (70%) women with Valsalva manoeuvre. Inter-observer variability was 0.84 (kappa, very good agreement, p = 0.001). Conclusion Trans-vaginal ultrasound is effective at demonstrating pelvic vein incompetence. All trans-vaginal ultrasound protocols should include assessment of pelvic veins in the supine and semi-standing position with Valsalva manoeuvre. [ABSTRACT FROM AUTHOR]

Examines the effectiveness of community clinics for leg ulcers in London, England. Treatment of leg ulceration; Bandage regimens for patients with differing ankle circumference; Details of patients presented to community clinics with leg ulceration.

Investigates the influence of smoking and plasma lipids on the patency of saphenous vein femoropopliteal bypass grafts in England. Role of smoking in the causation of peripheral arterial disease; Usefulness of apoprotein in predicting coronary heart disease; Measurement of apoliproteins using end point immunonephelometry.

Background: Despite NICE guidelines, the early management of deep vein thrombosis (DVT) in UK hospitals varies widely. We investigated the variation in clinical pathways used in NHS hospitals in North West England., Methods: A detailed questionnaire was sent to seventeen University or District General hospitals with an Accident and Emergency department. Copies of protocols or patient pathways were requested., Results: 15 hospitals responded despite our repeated requests for information. Of those, four hospitals did not provide any DVT protocol, guideline or service for DVT. In seven (63.6%) hospitals, possible DVT patients were assessed in A&E, and four (36.4%) in Acute Medical Admission Units. During the day, initial assessment was by a Specialist Nurse (SN)/Advance Nurse Practitioner (ANP) in 4 (36.4%) hospitals, by a doctor in 5 out of 11 hospitals (45.5%) and a combination of ANP and doctors in 2 out of 11 (18.2%) hospitals. Out of hours assessment was conducted by a doctor in all 11 hospitals (100%). Two (18.2%) hospitals used the 2003 Wells score, three (27.3%) used the 1997 Wells score and six (54.5%) hospitals used 'in house' modified Wells score. The score required to trigger further investigation varied between different hospitals. Only four (36.4%) hospitals could arrange US imaging within four hours of presentation., Conclusion: This lack of co-ordinated services for the management of DVT in the North West England is likely to reflect national practice. A national programme is urgently needed to ensure patients with suspected DVT are managed using standardised and consistent protocols., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

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.)